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General NPI Number Information
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NPI Number | 1962912287
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Entity Type | Individual
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Provider Name | JOHN LEWIS ROCHA II LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 2400 BELVIDERE RD
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City | WAUKEGAN
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State | IL
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Zip | 60085-6165
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Country | US
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Telephone | 847-377-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 8114 41ST AVE
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City | KENOSHA
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State | WI
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Zip | 53142-4544
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Country | US
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Telephone | 262-358-3592
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.019738
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License Number State | IL
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