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General NPI Number Information
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NPI Number | 1073786216
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Entity Type | Organization
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Legal Business Name | COUNSELING AND SPORT PSYCHOLOGY SERVICES, PLLC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 2 OVERHILL RD STE 400
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City | SCARSDALE
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State | NY
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Zip | 10583
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Country | US
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Telephone | 914-582-4268
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Fax |
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Provider Business Mailing Address
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Address Line | 2 OVERHILL RD STE 400
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City | SCARSDALE
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State | NY
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Zip | 10583-5316
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Country | US
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Telephone | 914-582-4268
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBORAH N ROCHE
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Credential | PH.D.
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Telephone | 914-582-4268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 017377
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License Number State | NY
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