Provider Demographics
NPI:1972969616
Name:LAROCQUE, MORIAH (LCSW)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:
Last Name:LAROCQUE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 S WARD CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-3841
Mailing Address - Country:US
Mailing Address - Phone:720-443-1021
Mailing Address - Fax:
Practice Address - Street 1:12157 W CEDAR DR STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2105
Practice Address - Country:US
Practice Address - Phone:720-443-1021
Practice Address - Fax:720-953-3898
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099276701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical