Provider Demographics
NPI:1235904103
Name:ROTCHFORD, LISA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:
Last Name:ROTCHFORD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 E CLEARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4438
Mailing Address - Country:US
Mailing Address - Phone:267-934-1962
Mailing Address - Fax:
Practice Address - Street 1:2437 E CLEARFIELD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4438
Practice Address - Country:US
Practice Address - Phone:267-934-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker