Provider Demographics
NPI:1295790095
Name:DAVIS, ROCHELLE L (ED D)
Entity type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MASSACHUSETTS AVE
Mailing Address - Street 2:STE 2B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-661-8836
Mailing Address - Fax:617-661-9677
Practice Address - Street 1:1105 MASSACHUSETTS AVE
Practice Address - Street 2:STE 2B
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-661-8836
Practice Address - Fax:617-661-9677
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist