Provider Demographics
NPI:1407173735
Name:FRITZ, ROCHELLE M (PHD)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:M
Last Name:FRITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2738
Mailing Address - Country:US
Mailing Address - Phone:401-369-9224
Mailing Address - Fax:401-369-9275
Practice Address - Street 1:1086 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2738
Practice Address - Country:US
Practice Address - Phone:401-369-9224
Practice Address - Fax:401-369-9275
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01536103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent