Provider Demographics
NPI:1235497579
Name:LA ROCHE, WHITNEY VERDIEU (MM,CAGS,)
Entity Type:Individual
Prefix:MR
First Name:WHITNEY
Middle Name:VERDIEU
Last Name:LA ROCHE
Suffix:
Gender:M
Credentials:MM,CAGS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MONPONSET ST
Mailing Address - Street 2:MATTAPAN
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3011
Mailing Address - Country:US
Mailing Address - Phone:617-800-3665
Mailing Address - Fax:
Practice Address - Street 1:27 MONPONSET ST
Practice Address - Street 2:MATTAPAN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-3011
Practice Address - Country:US
Practice Address - Phone:617-800-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3747P1801X3747P1801X
MA374U00000X374U00000X
MA376J00000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker