Healthcare Provider Details

I. General information

NPI: 1952820508
Provider Name (Legal Business Name): ROCHELLE JILL GORDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROCHELLE JILL HAUSMAN LCSW

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 COLUMBIA TPKE
FLORHAM PARK NJ
07932-1299
US

IV. Provider business mailing address

23 LONGACRE DR
LIVINGSTON NJ
07039-2250
US

V. Phone/Fax

Practice location:
  • Phone: 888-724-7123
  • Fax:
Mailing address:
  • Phone: 973-818-6496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04407300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: