Provider Demographics
NPI:1609277268
Name:ROCHE, SAMANTHA (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:ROCHE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1935
Mailing Address - Country:US
Mailing Address - Phone:631-317-9480
Mailing Address - Fax:631-277-6039
Practice Address - Street 1:128 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-1804
Practice Address - Country:US
Practice Address - Phone:631-317-9480
Practice Address - Fax:631-277-6039
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401987363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health