MEDICARE: VICTORIA MARIE ROCHA LPC

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	101YP2500X	Professional Counselor	LPC 00203	MN

General Provider Information

NPI Number	:	1902947286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MARIE ROCHA LPC

Provider Business Mailing Address
First Line	:	4517 MARIGOLD AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-1548
Country	:	US
Telephone Number	:	763-425-2142
Fax Number	:

Provider Business Practice Location Address
First Line	:	5831 74TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3109
Country	:	US
Telephone Number	:	952-451-3800
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	12/21/2007

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