=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316505886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE LOUISE ROCHA PHD, BCBA-D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2019
-----------------------------------------------------
Last Update Date | 05/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2825 50TH ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-2310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-723-7175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 45TH ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-723-7175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 1-12-10327
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------