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General NPI Number Information
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NPI Number | 1619210069
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Entity Type | Individual
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Provider Name | MICHAEL ROCHE MA
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Gender | Male
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 10/30/2021
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Provider Practice Location Address
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Address Line | 3771 NESCONSET HWY STE 214
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1154
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Country | US
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Telephone | 347-450-1136
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Fax | 347-294-4131
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Provider Business Mailing Address
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Address Line | 1650 SYAMORE AVE SUITE 39
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City | BOHEMIA
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State | NY
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Zip | 11716
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Country | US
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Telephone | 631-758-8290
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1068
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1068
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License Number State | NY
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