Provider Demographics
NPI:1255661666
Name:REID-BISPHAM, ROCHELLE DENISE (MA)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:DENISE
Last Name:REID-BISPHAM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N STATE ROAD 7 STE 211
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5625
Mailing Address - Country:US
Mailing Address - Phone:954-578-8399
Mailing Address - Fax:954-578-0145
Practice Address - Street 1:3500 N STATE ROAD 7 STE 211
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5625
Practice Address - Country:US
Practice Address - Phone:954-578-8399
Practice Address - Fax:954-578-0145
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health