Provider Demographics
NPI:1962108555
Name:ROCHE, MADDISON CHANDLER
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:CHANDLER
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 1:195 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1776
Mailing Address - Country:US
Mailing Address - Phone:617-835-7026
Mailing Address - Fax:
Practice Address - Street 1:195 E UNION ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721-1776
Practice Address - Country:US
Practice Address - Phone:617-835-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool