Provider Demographics
NPI:1124490248
Name:EUSSE-ROCHE, LUISA (MS ED)
Entity type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:EUSSE-ROCHE
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3701
Mailing Address - Country:US
Mailing Address - Phone:347-832-0035
Mailing Address - Fax:877-252-9381
Practice Address - Street 1:2515 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3701
Practice Address - Country:US
Practice Address - Phone:347-832-0035
Practice Address - Fax:877-252-9381
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator