Provider Demographics
NPI:1225202880
Name:ROCHA, GERALD (LCMHC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ROCHA
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5402
Mailing Address - Country:US
Mailing Address - Phone:401-722-5573
Mailing Address - Fax:401-726-5571
Practice Address - Street 1:1145 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5503
Practice Address - Country:US
Practice Address - Phone:603-431-6703
Practice Address - Fax:603-430-3753
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGH57134Medicaid
NH3078870Medicaid