MEDICARE: MRS. LEAH ROKEACH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	074401-1	NY

General Provider Information

NPI Number	:	1679718076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH ROKEACH LCSW

Provider Business Mailing Address
First Line	:	5404 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1804
Country	:	US
Telephone Number	:	917-306-3410
Fax Number	:	718-851-7338

Provider Business Practice Location Address
First Line	:	5404 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1804
Country	:	US
Telephone Number	:	917-306-3410
Fax Number	:	718-851-7338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2008
Last Update Date	:	12/13/2008

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