Provider Demographics
NPI:1033767470
Name:WADEHRA, ROCHE (LMFT)
Entity Type:Individual
Prefix:
First Name:ROCHE
Middle Name:
Last Name:WADEHRA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1002
Mailing Address - Country:US
Mailing Address - Phone:415-857-0989
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 986
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2913
Practice Address - Country:US
Practice Address - Phone:415-857-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87217106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist