Provider Demographics
NPI:1639298227
Name:MARISCAL-ROCHA, MICAELA (LCSW)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:MARISCAL-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 1:875 STEVENSON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-0901
Mailing Address - Country:US
Mailing Address - Phone:415-355-3680
Mailing Address - Fax:415-355-3683
Practice Address - Street 1:875 STEVENSON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-0901
Practice Address - Country:US
Practice Address - Phone:415-355-3680
Practice Address - Fax:415-355-3683
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS190651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
900OtherSFGH INTERNAL USE ONLY
900OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER