Provider Demographics
NPI:1861558108
Name:ROCCUCCI, ELIZABETH JANE (MFT INTERN)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANE
Last Name:ROCCUCCI
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14049 BOYS RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SLOUGHHOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9782
Mailing Address - Country:US
Mailing Address - Phone:916-355-8892
Mailing Address - Fax:916-355-8847
Practice Address - Street 1:14049 BOYS RANCH RD
Practice Address - Street 2:
Practice Address - City:SLOUGHHOUSE
Practice Address - State:CA
Practice Address - Zip Code:95683-9782
Practice Address - Country:US
Practice Address - Phone:916-355-8892
Practice Address - Fax:916-355-8847
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist