Provider Demographics
NPI:1841556586
Name:ROACHE, ORVILLE
Entity Type:Individual
Prefix:
First Name:ORVILLE
Middle Name:
Last Name:ROACHE
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 1:631 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3847
Mailing Address - Country:US
Mailing Address - Phone:650-364-7988
Mailing Address - Fax:650-364-7987
Practice Address - Street 1:2560 PULGAS AVE
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1323
Practice Address - Country:US
Practice Address - Phone:650-364-7988
Practice Address - Fax:650-364-7987
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)