Provider Demographics
NPI:1679697841
Name:ROCHA, KRISTEEN ELIZABETH (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEEN
Middle Name:ELIZABETH
Last Name:ROCHA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4131
Mailing Address - Country:US
Mailing Address - Phone:401-728-1800
Mailing Address - Fax:401-728-0182
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4131
Practice Address - Country:US
Practice Address - Phone:401-728-1800
Practice Address - Fax:401-728-0182
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical