Provider Demographics
NPI:1235319807
Name:KOHCHI, JOANIKO (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JOANIKO
Middle Name:
Last Name:KOHCHI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4075
Mailing Address - Country:US
Mailing Address - Phone:917-645-5097
Mailing Address - Fax:347-329-9073
Practice Address - Street 1:2715 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4075
Practice Address - Country:US
Practice Address - Phone:917-645-5097
Practice Address - Fax:347-329-9073
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49121041C0700X
NY080153-11041C0700X
LA58001041C0700X
MELC102111041C0700X
NJ44SC055163001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4172638Medicaid
TN11805357OtherCAQH
TN5442101Medicare PIN