Provider Demographics
NPI:1922716539
Name:LAROCHEL, MERTONANCE
Entity Type:Individual
Prefix:MS
First Name:MERTONANCE
Middle Name:
Last Name:LAROCHEL
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 1:10 WASHINGTON ST APT 33
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-6928
Mailing Address - Country:US
Mailing Address - Phone:239-784-3876
Mailing Address - Fax:
Practice Address - Street 1:10 WASHINGTON ST APT 33
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-6928
Practice Address - Country:US
Practice Address - Phone:239-784-3876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANA1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMAMedicaid
MAMAOtherMASS HEALTH