Healthcare Provider Details

I. General information

NPI: 1083208987
Provider Name (Legal Business Name): RESILIENCY AND OPTIMISM CHANGES LIVES (R.O.C.) THERAPEUTIC COACHING SE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WESTINGHOUSE PLZ STE A101
HYDE PARK MA
02136-2183
US

IV. Provider business mailing address

17 RICHMERE RD
MATTAPAN MA
02126-3201
US

V. Phone/Fax

Practice location:
  • Phone: 617-539-6448
  • Fax:
Mailing address:
  • Phone: 617-755-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. LAKISHA R AUSTIN
Title or Position: CEO/FOUNDER
Credential: LICSW, MBA, MSW
Phone: 617-755-6448