Healthcare Provider Details

I. General information

NPI: 1104006295
Provider Name (Legal Business Name): LISA GERRARD ROCHFORD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA GERRARD

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

IV. Provider business mailing address

811 S COLLEGE AVE
SALEM VA
24153-5165
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-3955
  • Fax: 540-387-3977
Mailing address:
  • Phone: 540-387-3955
  • Fax: 540-387-3977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003882
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: