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General NPI Number Information
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NPI Number | 1053649137
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Entity Type | Individual
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Provider Name | CHRISTINE ROCHE LMSW
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Gender | Female
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 623 NEW LOUDON RD
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City | LATHAM
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State | NY
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Zip | 12110-4031
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Country | US
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Telephone | 518-782-1178
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Fax | 518-782-3433
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Provider Business Mailing Address
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Address Line | 2354 HARRISON ST
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City | SCHENECTADY
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State | NY
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Zip | 12306-4440
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Country | US
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Telephone | 518-542-7650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 078630
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License Number State | NY
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