MEDICARE: ANNE MILLICENT ROCHE L.C.S.W.

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	1041C0700X	Clinical Social Worker	CSW002622	GA

General Provider Information

NPI Number	:	1790995520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MILLICENT ROCHE L.C.S.W.

Provider Business Mailing Address
First Line	:	2052 MCLENDON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1808
Country	:	US
Telephone Number	:	404-668-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2052 MCLENDON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-1808
Country	:	US
Telephone Number	:	404-668-7331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	06/08/2012

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