Provider Demographics
NPI:1013420181
Name:NJLAROCQUE COUNSELING, LLC
Entity Type:Organization
Organization Name:NJLAROCQUE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LAROCQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-331-1180
Mailing Address - Street 1:525 MASSACHUSETTS AVE STE 101F
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-2963
Mailing Address - Country:US
Mailing Address - Phone:617-331-1180
Mailing Address - Fax:888-430-8150
Practice Address - Street 1:525 MASSACHUSETTS AVE STE 101F
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-2963
Practice Address - Country:US
Practice Address - Phone:617-331-1180
Practice Address - Fax:888-430-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114971261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health