Provider Demographics
NPI:1124508015
Name:ROCHA, DIANE M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:ROCHA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JESSICA DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-4342
Mailing Address - Country:US
Mailing Address - Phone:774-930-0174
Mailing Address - Fax:
Practice Address - Street 1:275 MARTINE ST STE 109
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1518
Practice Address - Country:US
Practice Address - Phone:508-235-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116453104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker