Healthcare Provider Details

I. General information

NPI: 1902924798
Provider Name (Legal Business Name): NICHOLAS JOHN ROHALL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 W STATE ST
NEW CASTLE PA
16101-8645
US

IV. Provider business mailing address

2703 W STATE ST
NEW CASTLE PA
16101-8671
US

V. Phone/Fax

Practice location:
  • Phone: 724-657-3033
  • Fax: 724-657-3326
Mailing address:
  • Phone: 724-657-3303
  • Fax: 724-657-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW015341
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCW015341
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015341
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: