Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 1853704 | NY |
NPI | 1033553318 |
---|---|
Provider Name | Mrs. Courtney Jeanne Roche |
First Address | Huntington, NY 11743-4942 |
Second Address | Huntington, NY 11743-4942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2013 |
Last Update Date | 17/04/2013 |