Provider Demographics
NPI:1235254244
Name:DAVID, ROCHEL SURICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROCHEL
Middle Name:SURICK
Last Name:DAVID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3007
Mailing Address - Country:US
Mailing Address - Phone:201-837-0238
Mailing Address - Fax:
Practice Address - Street 1:163 ENGLE ST
Practice Address - Street 2:205
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2535
Practice Address - Country:US
Practice Address - Phone:201-563-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ002212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist