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General NPI Number Information
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NPI Number | 1396135935
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Entity Type | Individual
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Provider Name | JACOBA ROCK LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 126 THORNTON RD
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City | STATE COLLEGE
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State | PA
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Zip | 16801-7242
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Country | US
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Telephone | 303-834-5893
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Fax |
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Provider Business Mailing Address
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Address Line | 126 THORNTON RD
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City | STATE COLLEGE
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State | PA
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Zip | 16801-7242
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Country | US
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Telephone | 303-834-5893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW.09923456
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 27288251
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License Number State | PA
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