Provider Demographics
NPI:1659156214
Name:FOOTE, ROCHELLE AMANDA (PMHNP, RN)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:AMANDA
Last Name:FOOTE
Suffix:
Gender:F
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLOCK TOWER CMNS
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-231-0321
Mailing Address - Fax:
Practice Address - Street 1:21 OLD MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1883
Practice Address - Country:US
Practice Address - Phone:845-231-0321
Practice Address - Fax:877-309-4691
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY714564163W00000X
NY405543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLICENSEOther405543