Healthcare Provider Details

I. General information

NPI: 1952229254
Provider Name (Legal Business Name): SEAN MICHAEL ROCHE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12478 TULIP CT
RANCHO CUCAMONGA CA
91739-1624
US

IV. Provider business mailing address

12478 TULIP CT
RANCHO CUCAMONGA CA
91739-1624
US

V. Phone/Fax

Practice location:
  • Phone: 909-231-2656
  • Fax:
Mailing address:
  • Phone: 909-231-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: