Provider Demographics
NPI:1215198494
Name:BOCKO, MIRANDA F (MA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:F
Last Name:BOCKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-2207
Mailing Address - Country:US
Mailing Address - Phone:603-431-5112
Mailing Address - Fax:
Practice Address - Street 1:141 UNION ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5563
Practice Address - Country:US
Practice Address - Phone:603-625-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health