Provider Demographics
NPI:1467764233
Name:ROCHA, REVA K (LCSW)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:K
Last Name:ROCHA
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 1:902 N. RIVERSIDE RD.
Mailing Address - Street 2:STE. 100
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2552
Mailing Address - Country:US
Mailing Address - Phone:816-271-1350
Mailing Address - Fax:816-271-1355
Practice Address - Street 1:902 N. RIVERSIDE RD.
Practice Address - Street 2:STE. 100
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2552
Practice Address - Country:US
Practice Address - Phone:816-271-1350
Practice Address - Fax:816-271-1355
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040163521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical