Provider Demographics
NPI:1316437965
Name:ROCHE, LISA E
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:ROCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GORDON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1323
Mailing Address - Country:US
Mailing Address - Phone:978-808-4138
Mailing Address - Fax:
Practice Address - Street 1:50 GORDON MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1323
Practice Address - Country:US
Practice Address - Phone:978-808-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA455767OtherMA TEACHERS CERTIFICATION