Provider Demographics
NPI:1992133482
Name:ROCHE, MARCIA (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:ROCHE
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 1:89 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2467
Mailing Address - Country:US
Mailing Address - Phone:860-373-8421
Mailing Address - Fax:978-233-4856
Practice Address - Street 1:89 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2467
Practice Address - Country:US
Practice Address - Phone:978-307-8654
Practice Address - Fax:978-233-4856
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078870Medicaid
NH3078870Medicaid