Provider Demographics
NPI:1538900725
Name:ROCKETTE, MICKAELLE (PCMSW, PLMHP)
Entity type:Individual
Prefix:
First Name:MICKAELLE
Middle Name:
Last Name:ROCKETTE
Suffix:
Gender:F
Credentials:PCMSW, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4621
Mailing Address - Country:US
Mailing Address - Phone:636-866-1355
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVENUE
Practice Address - Street 2:117C- DORCAS
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-977-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79661041C0700X
NE137391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical