Provider Demographics
NPI:1275863110
Name:SOROTZKIN, RACHEL (MA BCBA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SOROTZKIN
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HADASSAH LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5559
Mailing Address - Country:US
Mailing Address - Phone:732-598-1316
Mailing Address - Fax:
Practice Address - Street 1:112 HADASSAH LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5559
Practice Address - Country:US
Practice Address - Phone:732-598-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-27
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1063195103K00000X
NJ1041612103K00000X
NJ47Y500613400235Z00000X
NJ46TR00359300174400000X
NJ46TR00021900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist