Provider Demographics
NPI:1427217991
Name:ROCHE, SUSAN VARADY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VARADY
Last Name:ROCHE
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 1:13405 CEDARVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7641
Mailing Address - Country:US
Mailing Address - Phone:719-393-2027
Mailing Address - Fax:855-282-0728
Practice Address - Street 1:13405 CEDARVILLE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-7641
Practice Address - Country:US
Practice Address - Phone:719-393-2027
Practice Address - Fax:855-282-0728
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3062103TC0700X
CO3702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical