Individual
MS. MARY A LAROCQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
7806 W JEFFERSON BLVD STE C, FORT WAYNE, IN 46804-4180
(260) 203-4188
(260) 203-5136
Mailing address
7311A W JEFFERSON BLVD, FORT WAYNE, IN 46804-6237
(260) 471-8033
(260) 471-8107
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001252A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200800080
—
IN
Enumeration date
08/04/2006
Last updated
09/19/2022
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