1205427853 NPI number — MS. BRANDI NICOLE ROCCHETTI M.S.W

Table of content: MS. BRANDI NICOLE ROCCHETTI M.S.W (NPI 1205427853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205427853 NPI number — MS. BRANDI NICOLE ROCCHETTI M.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCCHETTI
Provider First Name:
BRANDI
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POOLE
Provider Other First Name:
BRANDI
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205427853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COUNCIL OF THE SOUTHERN MOUNTAINS
Provider Second Line Business Mailing Address:
148 MCDOWELL ST
Provider Business Mailing Address City Name:
WELCH
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-436-6800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COUNCIL OF THE SOUTHERN MOUNTAINS
Provider Second Line Business Practice Location Address:
148 MCDOWELL ST
Provider Business Practice Location Address City Name:
WELCH
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-436-6800
Provider Business Practice Location Address Fax Number:
304-436-6803
Provider Enumeration Date:
01/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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