Healthcare Provider Details

I. General information

NPI: 1386570653
Provider Name (Legal Business Name): SAMANTHA ROCHE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 N MAIN ST STE 301
BEL AIR MD
21014-8808
US

IV. Provider business mailing address

1863 EDGEWOOD RD
TOWSON MD
21286-8907
US

V. Phone/Fax

Practice location:
  • Phone: 443-567-7037
  • Fax: 443-390-1136
Mailing address:
  • Phone: 410-491-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberA01160
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: