Provider Demographics
NPI:1285410464
Name:JOHN, ROCHELLE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:EVERSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:7 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980-9649
Mailing Address - Country:US
Mailing Address - Phone:646-837-1973
Mailing Address - Fax:
Practice Address - Street 1:7 GRAND AVE
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980-9649
Practice Address - Country:US
Practice Address - Phone:646-837-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113760-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker