Healthcare Provider Details

I. General information

NPI: 1033343314
Provider Name (Legal Business Name): ZIPORA ROKACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 56TH ST
BROOKLYN NY
11219-4618
US

IV. Provider business mailing address

1447 56TH ST
BROOKLYN NY
11219-4618
US

V. Phone/Fax

Practice location:
  • Phone: 718-436-4067
  • Fax: 718-331-9403
Mailing address:
  • Phone: 718-436-4065
  • Fax: 718-331-9403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRO44121O
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO44121O
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: