Healthcare Provider Details

I. General information

NPI: 1508509381
Provider Name (Legal Business Name): MAGDALENA ELIZABETH ROCHA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGI ELIZABETH ROCHA LCSW

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 CARRIE FROST DRIVE SUITE LL2
STEVENS POINT WI
54482
US

IV. Provider business mailing address

PO BOX 52
PLOVER WI
54467-0052
US

V. Phone/Fax

Practice location:
  • Phone: 715-204-4299
  • Fax:
Mailing address:
  • Phone: 715-204-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11121-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: