Provider Demographics
NPI:1154864122
Name:ROCHE, CASEY (MED, NCSP)
Entity Type:Individual
Prefix:MISS
First Name:CASEY
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PLEASANTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14572-1221
Mailing Address - Country:US
Mailing Address - Phone:585-406-5563
Mailing Address - Fax:
Practice Address - Street 1:101 PLEASANTSIDE DR
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:NY
Practice Address - Zip Code:14572-1221
Practice Address - Country:US
Practice Address - Phone:585-406-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool