Healthcare Provider Details

I. General information

NPI: 1144865494
Provider Name (Legal Business Name): MALAYNA ROCCA BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 165TH STREET RD STE 100
MIAMI FL
33169-6306
US

IV. Provider business mailing address

14850 W DIXIE HWY APT 118
NORTH MIAMI FL
33181-1035
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-2272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: