Healthcare Provider Details

I. General information

NPI: 1518112424
Provider Name (Legal Business Name): VERA PATRICIA ROQUEMORE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVENUE RM. 12-190
EAST ORANGE NJ
07018
US

IV. Provider business mailing address

1305 PASSAIC AVE
LINDEN NJ
07036-1810
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax:
Mailing address:
  • Phone: 202-262-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3613
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3613
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3613
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number3613
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: