Healthcare Provider Details

I. General information

NPI: 1679718076
Provider Name (Legal Business Name): LEAH ROKEACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2008
Last Update Date: 12/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 16TH AVE
BROOKLYN NY
11204-1804
US

IV. Provider business mailing address

5404 16TH AVE
BROOKLYN NY
11204-1804
US

V. Phone/Fax

Practice location:
  • Phone: 917-306-3410
  • Fax: 718-851-7338
Mailing address:
  • Phone: 917-306-3410
  • Fax: 718-851-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074401-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: