Provider Demographics
NPI:1043623564
Name:ROCHA, HEATHER MAE (MS)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MAE
Last Name:ROCHA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:MAE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 WESNER LN # MC24-80
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-8023
Mailing Address - Country:US
Mailing Address - Phone:570-214-3152
Mailing Address - Fax:570-214-7342
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:MC 26-20
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-214-3152
Practice Address - Fax:570-214-7342
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
PAGC000198170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS