Provider Demographics
NPI:1184258428
Name:ROCKETT, MICHELE ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANNE
Last Name:ROCKETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ANNE
Other - Last Name:FELLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94-1093 KAPEHU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5401
Mailing Address - Country:US
Mailing Address - Phone:808-772-6193
Mailing Address - Fax:
Practice Address - Street 1:94-1093 KAPEHU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5401
Practice Address - Country:US
Practice Address - Phone:808-772-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-41411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical