Healthcare Provider Details

I. General information

NPI: 1518736602
Provider Name (Legal Business Name): JENAE NICOLE ROACHE MA, BCBA, LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 COCHITUATE RD
FRAMINGHAM MA
01701-4608
US

IV. Provider business mailing address

260 COCHITUATE RD
FRAMINGHAM MA
01701-4608
US

V. Phone/Fax

Practice location:
  • Phone: 800-679-3609
  • Fax: 718-819-1801
Mailing address:
  • Phone: 800-679-3609
  • Fax: 718-819-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10002222
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: