Provider Demographics
NPI:1023498169
Name:ROCHE, SHACARA
Entity type:Individual
Prefix:
First Name:SHACARA
Middle Name:
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 1:794 BABBITT RD # UP
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2503
Mailing Address - Country:US
Mailing Address - Phone:216-925-7879
Mailing Address - Fax:
Practice Address - Street 1:794 BABBITT RD # UP
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2503
Practice Address - Country:US
Practice Address - Phone:216-925-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RT563173OtherDRIVER LICENSE NUMBER