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General NPI Number Information
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NPI Number | 1407306962
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Entity Type | Individual
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Provider Name | PETER BROOK ROCKHOLZ LCSW, M.S.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/09/2016
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Last Update Date | 10/09/2016
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Provider Practice Location Address
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Address Line | 81 BOWMAN DR
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City | GREENWICH
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State | CT
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Zip | 06831-3238
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Country | US
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Telephone | 203-313-1418
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Fax |
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Provider Business Mailing Address
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Address Line | 81 BOWMAN DR
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City | GREENWICH
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State | CT
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Zip | 06831-3238
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Country | US
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Telephone | 203-313-1418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 001727
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License Number State | CT
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