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General NPI Number Information
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NPI Number | 1689731952
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Entity Type | Individual
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Provider Name | REBECCA ANN ROCHE LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 712 MAIN ST SUITE L-2
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City | BUFFALO
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State | NY
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Zip | 14202-1720
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Country | US
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Telephone | 716-854-5242
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Fax |
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Provider Business Mailing Address
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Address Line | 346 E RIVER RD
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City | GRAND ISLAND
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State | NY
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Zip | 14072-3018
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Country | US
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Telephone | 716-773-6231
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R042611-1
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License Number State | NY
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