Provider Demographics
NPI:1760965172
Name:TROCHE, CAROLYN (TEACHER)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TROCHE
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 ALCAZAR DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4719
Mailing Address - Country:US
Mailing Address - Phone:305-742-3475
Mailing Address - Fax:
Practice Address - Street 1:2813 ALCAZAR DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4719
Practice Address - Country:US
Practice Address - Phone:305-742-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-55237106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL700088Medicaid