MEDICARE: LU ROCHA COUNSELING SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1467938712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LU ROCHA COUNSELING SERVICES PC

Provider Business Mailing Address
First Line	:	4071 N BROADWAY ST STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2117
Country	:	US
Telephone Number	:	773-203-1328
Fax Number	:

Provider Business Practice Location Address
First Line	:	4071 N BROADWAY ST STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2117
Country	:	US
Telephone Number	:	773-203-1328
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, PSYCHOTHERAPIST
Name	:	LOURDES ROCHA
Credential	:	LCSW
Telephone Number	:	773-217-8571

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	01/04/2023

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