Healthcare Provider Details

I. General information

NPI: 1811608458
Provider Name (Legal Business Name): DARYNE M ROCKETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANDALA COUNSELING AND CREATIVE ARTS LLC

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 MAIN ST
ORONO ME
04473-3439
US

IV. Provider business mailing address

291 MAIN ST
ORONO ME
04473-3439
US

V. Phone/Fax

Practice location:
  • Phone: 207-881-3134
  • Fax:
Mailing address:
  • Phone: 207-881-3134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10787
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: