Provider Demographics
NPI:1033793658
Name:PRADHAN, ROCHAK (RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROCHAK
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CHERRY ST STE 15
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3555
Mailing Address - Country:US
Mailing Address - Phone:203-876-0545
Mailing Address - Fax:938-253-3590
Practice Address - Street 1:204 CHERRY ST STE 15
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3555
Practice Address - Country:US
Practice Address - Phone:203-876-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10453363LP0808X
CT103107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse