MEDICARE: MR. NICHOLAS FRANCIS ROCCA L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	12818	CA

General Provider Information

NPI Number	:	1659372456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS FRANCIS ROCCA L.C.S.W.

Provider Business Mailing Address
First Line	:	1172 N MACLAY AVE
Second Line	:
City	:	SAN FERNANDO
State	:	CA
Zip	:	91340-1328
Country	:	US
Telephone Number	:	818-898-1388
Fax Number	:	818-365-4031

Provider Business Practice Location Address
First Line	:	22900 VENTURA BLVD
Second Line	:	STE A
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-5831
Country	:	US
Telephone Number	:	818-988-6335
Fax Number	:	818-988-2140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	12/27/2021

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