Provider Demographics
NPI:1255768867
Name:ROCHA, MAXIMILIAN ANTHONY JOSEPH (LCSW)
Entity type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:ANTHONY JOSEPH
Last Name:ROCHA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 MOUNTAIN GATE WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2717
Mailing Address - Country:US
Mailing Address - Phone:415-713-7990
Mailing Address - Fax:
Practice Address - Street 1:1380 HOWARD ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2652
Practice Address - Country:US
Practice Address - Phone:415-255-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19977104100000X
CALCS199771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker