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General NPI Number Information
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NPI Number | 1912184862
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Entity Type | Individual
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Provider Name | PATRICIA ANN ROCHE LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 776 MAIN ST UNIT 540542
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City | WALTHAM
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State | MA
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Zip | 02451-0619
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Country | US
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Telephone | 617-959-4509
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Fax | 781-899-4001
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Provider Business Mailing Address
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Address Line | PO BOX 540542
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City | WALTHAM
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State | MA
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Zip | 02454-0542
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Country | US
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Telephone |
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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 | 113045
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License Number State | MA
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