Provider Demographics
NPI:1558843987
Name:ROCHA, MARY H (MSW-LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:ROCHA
Suffix:
Gender:F
Credentials:MSW-LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 VEAZIE RD.
Mailing Address - Street 2:
Mailing Address - City:SWANVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4580
Mailing Address - Country:US
Mailing Address - Phone:207-307-0328
Mailing Address - Fax:
Practice Address - Street 1:70 VEAZIE RD.
Practice Address - Street 2:
Practice Address - City:SWANVILLE
Practice Address - State:ME
Practice Address - Zip Code:04915-4580
Practice Address - Country:US
Practice Address - Phone:207-307-0328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-01
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015404-SW-LICSW1041C0700X
MA10154041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical