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General NPI Number Information
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NPI Number | 1912137480
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Entity Type | Individual
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Provider Name | BRIDGET LAROCHE LCSW, LADC
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 32 MAIN ST # 5
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City | LIVERMORE FALLS
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State | ME
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Zip | 04254-1244
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Country | US
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Telephone | 207-200-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 682 BOOTHBY RD
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City | LIVERMORE
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State | ME
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Zip | 04253-4020
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Country | US
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Telephone | 207-653-9191
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LC4927
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC18515
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License Number State | ME
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