Provider Demographics
NPI:1730654583
Name:ROCHE, JENNIFER MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:938 NINA ELIZABETH CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4536
Mailing Address - Country:US
Mailing Address - Phone:813-965-8796
Mailing Address - Fax:813-236-7551
Practice Address - Street 1:938 NINA ELIZABETH CIR APT 101
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4536
Practice Address - Country:US
Practice Address - Phone:813-965-8796
Practice Address - Fax:813-236-7551
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty