Provider Demographics
NPI:1336701101
Name:TRICOCHE, ELISSA N (RBT)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:N
Last Name:TRICOCHE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 NW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1943
Mailing Address - Country:US
Mailing Address - Phone:954-857-5023
Mailing Address - Fax:
Practice Address - Street 1:5500 HILLSBORO BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:305-305-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician