Provider Demographics
NPI:1376017608
Name:ROCA MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:ROCA MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:ROCA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-614-1989
Mailing Address - Street 1:2460 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6612
Mailing Address - Country:US
Mailing Address - Phone:718-614-1989
Mailing Address - Fax:
Practice Address - Street 1:318 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3941
Practice Address - Country:US
Practice Address - Phone:718-356-9222
Practice Address - Fax:718-605-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104201227Medicaid