Provider Demographics
NPI:1508509381
Name:ROCHA, MAGDALENA ELIZABETH (CAPSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:ELIZABETH
Last Name:ROCHA
Suffix:
Gender:F
Credentials:CAPSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3667
Mailing Address - Country:US
Mailing Address - Phone:715-340-7744
Mailing Address - Fax:
Practice Address - Street 1:630 S 36TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3930
Practice Address - Country:US
Practice Address - Phone:715-842-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health