Kenneth J Roche, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

004685-1 Issued in NY

Practice address

200 Carleton Ave Ste D
East Islip, NY 11730-1222

Phone

(631) 579-3503

Fax

(631) 446-1136

NPI assigned

Mar 26, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Shore Mental Health Counseling Services,PC

  • Professional Counselor
  • East Islip, NY
  • NPI 1366890949
  NPD Authorized official
• South Shore Collaborative Psychiatry NP PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Amityville, NY
  • NPI 1942882246
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1578862728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 BEAVER DAM RD",
            "city": "ISLIP",
            "state": "NY",
            "postal_code": "117511935",
            "telephone_number": "631-235-4481",
            "fax_number": "631-277-6039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CARLETON AVE STE D",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117301222",
            "telephone_number": "631-579-3503",
            "fax_number": "631-446-1136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROCHE",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-26",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "004685-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Rivera
• RM Massage Therapy PC
• Lynn Robbins, R.PH.
• Robert Teisch & Joseph a Simonetti and Robert Domozych DDS PC
• Robin Stein DC PC
• Kimberly J Rodgers, DNP
• Joan Ann Rodriguez, L.M.T
• Lorenzo Rodriguez, A.A., CASAC
• Cara N Romano, MHC
• Lisa Anne Romano, RN

• Mental Health Counselor in East Islip, NY
• Providers in East Islip, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.