Provider Demographics
NPI:1801193966
Name:ROCHA, MARTA KELLY (MA)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:KELLY
Last Name:ROCHA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 CRANES COVE LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7513
Mailing Address - Country:US
Mailing Address - Phone:407-227-5712
Mailing Address - Fax:
Practice Address - Street 1:7450 DR PHILLIPS BLVD STE 303
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5120
Practice Address - Country:US
Practice Address - Phone:407-453-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health