Provider Demographics
NPI:1073730628
Name:FRANK, ROCHELLE IVY (PHD)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:IVY
Last Name:FRANK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1613
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6613
Mailing Address - Country:US
Mailing Address - Phone:925-648-4800
Mailing Address - Fax:925-648-2530
Practice Address - Street 1:4185 BLACKHAWK PLAZA CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4694
Practice Address - Country:US
Practice Address - Phone:925-648-4800
Practice Address - Fax:925-648-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 14928OtherSTATE LICENSE