Provider Demographics
NPI:1316540909
Name:ERVIN, ROCHELLE LOIS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:LOIS
Last Name:ERVIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 FOXWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3023
Mailing Address - Country:US
Mailing Address - Phone:724-372-0762
Mailing Address - Fax:
Practice Address - Street 1:1530 FOXWOOD PASS
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3023
Practice Address - Country:US
Practice Address - Phone:724-372-0762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0222001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical