=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013172667
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL RANDALL ROCK LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2008
-----------------------------------------------------
Last Update Date | 07/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11311 N SEVEN FALLS DR
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-7966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-283-3978
-----------------------------------------------------
Fax | 520-797-1931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11311 N SEVEN FALLS DR
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-7966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-283-3978
-----------------------------------------------------
Fax | 520-797-1931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW- 13463
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-19613
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------