Healthcare Provider Details

I. General information

NPI: 1164580437
Provider Name (Legal Business Name): ROCHELLE WALLACH M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROCHELLE DACH M.S.W., L.C.S.W.

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FOX HILL DR
PERRINEVILLE NJ
08535-1107
US

IV. Provider business mailing address

5 FOX HILL DR
PERRINEVILLE NJ
08535-1107
US

V. Phone/Fax

Practice location:
  • Phone: 732-446-9400
  • Fax: 732-446-3198
Mailing address:
  • Phone: 732-446-9400
  • Fax: 732-446-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00528500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: