Provider Demographics
NPI:1194372706
Name:ROCKE, LATISHA ADUNNI
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:ADUNNI
Last Name:ROCKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9838
Mailing Address - Country:US
Mailing Address - Phone:678-634-9526
Mailing Address - Fax:
Practice Address - Street 1:137 GOLD ST
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-9838
Practice Address - Country:US
Practice Address - Phone:678-634-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR59834141OtherBLUE CROSS BLUE SHIELD