Healthcare Provider Details

I. General information

NPI: 1972113371
Provider Name (Legal Business Name): JAZMINE A ROCHA ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE UNIT 311
FRESNO CA
93705-4218
US

IV. Provider business mailing address

2550 W CLINTON AVE STE 125 BUILDING A
FRESNO CA
93705-4206
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 559-341-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number95131
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: