Provider Demographics
NPI:1114172152
Name:VOTH, ROCHELLE DIANE (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:DIANE
Last Name:VOTH
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34494
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-4494
Mailing Address - Country:US
Mailing Address - Phone:619-261-8510
Mailing Address - Fax:619-623-3325
Practice Address - Street 1:3312 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5713
Practice Address - Country:US
Practice Address - Phone:619-261-8510
Practice Address - Fax:619-623-3325
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22284103T00000X
CA1-03-1092103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst