Provider Demographics
NPI:1952655250
Name:ROCKE, LISSA ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISSA
Middle Name:ELLEN
Last Name:ROCKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1873
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650
Mailing Address - Country:US
Mailing Address - Phone:916-759-3028
Mailing Address - Fax:
Practice Address - Street 1:2791 SWETZER RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-9514
Practice Address - Country:US
Practice Address - Phone:916-759-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17071103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical