Healthcare Provider Details

I. General information

NPI: 1740201383
Provider Name (Legal Business Name): HELENA A ROCHA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 W BROADWAY 2ND FLOOR
BOSTON MA
02127-2215
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-464-5875
  • Fax: 617-464-5878
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMA101848
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: