Provider Demographics
NPI:1679224380
Name:ROCHA, ROBERT MATHEW
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MATHEW
Last Name:ROCHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13481 W MCDOWELL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2725
Mailing Address - Country:US
Mailing Address - Phone:623-471-5586
Mailing Address - Fax:
Practice Address - Street 1:13481 W MCDOWELL RD STE 400
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2725
Practice Address - Country:US
Practice Address - Phone:623-471-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD11077658106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician