Provider Demographics
NPI:1780217109
Name:ROCCO, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ROCCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 DE JESUS DR
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5120
Mailing Address - Country:US
Mailing Address - Phone:714-553-3903
Mailing Address - Fax:
Practice Address - Street 1:22600 SAVI RANCH PKWY # A23
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-4606
Practice Address - Country:US
Practice Address - Phone:714-587-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6137621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty