Provider Demographics
NPI:1386376176
Name:SPEARE, ROCHELLE DIANE I (LCSW R)
Entity type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:DIANE
Last Name:SPEARE
Suffix:I
Gender:F
Credentials:LCSW R
Other - Prefix:MRS
Other - First Name:ROCHELLE
Other - Middle Name:D
Other - Last Name:FAZIO
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:18369 NW CHEMEKETA LN APT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3527
Mailing Address - Country:US
Mailing Address - Phone:503-957-3138
Mailing Address - Fax:
Practice Address - Street 1:18369 NW CHEMEKETA LN APT A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3527
Practice Address - Country:US
Practice Address - Phone:503-957-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0422931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty