Individual
KELLY DEROCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA, PLPC
Contact information
Practice address
4201 N I 10 SERVICE RD W, METAIRIE, LA 70006
(888) 880-9270
(954) 342-0273
Mailing address
500 FAIRWAY DR STE 102, DEERFIELD BEACH, FL 33441-1817
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/06/2015
Last updated
09/07/2018
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