Healthcare Provider Details

I. General information

NPI: 1366376907
Provider Name (Legal Business Name): JUSTIN KYLE ROCKITTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BEDFORD RD
MOUNT KISCO NY
10549-3425
US

IV. Provider business mailing address

1844 DENVER RD
WANTAGH NY
11793-3625
US

V. Phone/Fax

Practice location:
  • Phone: 646-359-2887
  • Fax:
Mailing address:
  • Phone: 646-359-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP143184
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: