Provider Demographics
NPI:1083738603
Name:ROCKETT, GERALDINE MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:MARY
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:ROCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LP PLLC
Mailing Address - Street 1:1895 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5949
Mailing Address - Country:US
Mailing Address - Phone:651-644-4386
Mailing Address - Fax:
Practice Address - Street 1:1895 LAUREL AVE
Practice Address - Street 2:ST. MARY'S EPISCOPAL CHURCH OFFICE BUILDING
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5938
Practice Address - Country:US
Practice Address - Phone:651-294-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPO439103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling