Provider Demographics
NPI:1194074575
Name:RENDER, ROCHELLE A (CASAC-T)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:A
Last Name:RENDER
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 LINCOLN AVE
Mailing Address - Street 2:APT# 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4002
Mailing Address - Country:US
Mailing Address - Phone:347-663-5810
Mailing Address - Fax:
Practice Address - Street 1:1300 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1106
Practice Address - Country:US
Practice Address - Phone:718-954-3800
Practice Address - Fax:718-954-3767
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27163101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)