Provider Demographics
NPI:1972756120
Name:BOROCK, VALERIE STAAL
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:STAAL
Last Name:BOROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:MARGOT
Other - Last Name:STAAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, MS ED
Mailing Address - Street 1:176 E 77TH ST
Mailing Address - Street 2:APT. 2H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1908
Mailing Address - Country:US
Mailing Address - Phone:212-879-6165
Mailing Address - Fax:
Practice Address - Street 1:176 E 77TH ST
Practice Address - Street 2:APT. 2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1908
Practice Address - Country:US
Practice Address - Phone:212-879-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020000-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker