Provider Demographics
NPI:1164580437
Name:WALLACH, ROCHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:WALLACH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:DACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:PERRINEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08535-1107
Mailing Address - Country:US
Mailing Address - Phone:732-446-9400
Mailing Address - Fax:732-446-3198
Practice Address - Street 1:5 FOX HILL DR
Practice Address - Street 2:
Practice Address - City:PERRINEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08535-1107
Practice Address - Country:US
Practice Address - Phone:732-446-9400
Practice Address - Fax:732-446-3198
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005285001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical