Provider Demographics
NPI:1649711938
Name:ROCHE MOYANO, JULIO ANGEL (MS, LMHC)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:ANGEL
Last Name:ROCHE MOYANO
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 WEST FOREST HILL BOULEVARD
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-501-3517
Mailing Address - Fax:
Practice Address - Street 1:12777 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4775
Practice Address - Country:US
Practice Address - Phone:561-501-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health