Provider Demographics
NPI:1518248186
Name:POWELL, ROCHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:CORNWALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1322 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5410
Mailing Address - Country:US
Mailing Address - Phone:954-604-8243
Mailing Address - Fax:
Practice Address - Street 1:4540 LAFAYETTE ST STE C
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3236
Practice Address - Country:US
Practice Address - Phone:850-942-2000
Practice Address - Fax:850-942-2003
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty