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General NPI Number Information
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NPI Number | 1619279387
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Entity Type | Individual
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Provider Name | MARY ANN ROCCO L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 12550 NEW BRITTANY BLVD
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City | FORT MYERS
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State | FL
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Zip | 33907-3655
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Country | US
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Telephone | 239-343-3630
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Fax | 239-343-2968
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-424-1400
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Fax | 239-424-1421
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW4552
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License Number State | FL
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