Healthcare Provider Details

I. General information

NPI: 1316600125
Provider Name (Legal Business Name): DALLAS JAMES ROCKWELL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 CHENANGO ST
BINGHAMTON NY
13901-1653
US

IV. Provider business mailing address

1182 CHENANGO ST
BINGHAMTON NY
13901-1653
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-6904
  • Fax: 607-722-4123
Mailing address:
  • Phone: 607-772-6904
  • Fax: 607-722-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113943
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: