Provider Demographics
NPI:1508901950
Name:ROQUE, LUZ E (MED)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:E
Last Name:ROQUE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:M
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:104 SAFFRON CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1513
Mailing Address - Country:US
Mailing Address - Phone:413-783-5949
Mailing Address - Fax:
Practice Address - Street 1:235 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1100
Practice Address - Country:US
Practice Address - Phone:413-734-4978
Practice Address - Fax:413-734-0467
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health