Provider Demographics
NPI:1700617677
Name:BERRIOS MEDINA, ROCHELLE MEDINA (LCSW)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:MEDINA
Last Name:BERRIOS MEDINA
Suffix:
Gender:F
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:URB LA RAMBLA 1787
Mailing Address - Street 2:CALLE SIERVAS DE MARIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-298-9797
Mailing Address - Fax:
Practice Address - Street 1:URB LA RAMBLA 1787
Practice Address - Street 2:CALLE SIERVAS DE MARIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-974-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR169141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical