Provider Demographics
NPI:1104967124
Name:ROCHELLE, JUDITH LOUISE (MFCC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LOUISE
Last Name:ROCHELLE
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12544 CHETENHAM LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1004
Mailing Address - Country:US
Mailing Address - Phone:858-451-3317
Mailing Address - Fax:858-451-3317
Practice Address - Street 1:327 S IVY ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4337
Practice Address - Country:US
Practice Address - Phone:760-484-7829
Practice Address - Fax:760-294-2151
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist