1386376176 NPI number — MS. ROCHELLE DIANE SPEARE I LCSW R

Table of content: MS. ROCHELLE DIANE SPEARE I LCSW R (NPI 1386376176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386376176 NPI number — MS. ROCHELLE DIANE SPEARE I LCSW R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEARE
Provider First Name:
ROCHELLE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
I
Provider Credential Text:
LCSW R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAZIO
Provider Other First Name:
ROCHELLE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386376176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18369 NW CHEMEKETA LN APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97229-3527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-957-3138
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18369 NW CHEMEKETA LN APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97229-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-957-3138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2022

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: 1041C0700X , with the licence number:  042293 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com