Healthcare Provider Details

I. General information

NPI: 1104248343
Provider Name (Legal Business Name): CAROL DEROCHIE ALBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CAROL LYNN DEROCHIE

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CROSSROADS BLVD STE 250
SAN ANTONIO TX
78201-6523
US

IV. Provider business mailing address

96 CROSSROADS BLVD STE 250
SAN ANTONIO TX
78201-6523
US

V. Phone/Fax

Practice location:
  • Phone: 210-736-0106
  • Fax: 210-736-2609
Mailing address:
  • Phone: 210-736-0106
  • Fax: 210-736-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: