Provider Demographics
NPI:1407306962
Name:ROCKHOLZ, PETER BROOK (LCSW, MSSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:BROOK
Last Name:ROCKHOLZ
Suffix:
Gender:M
Credentials:LCSW, MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BOWMAN DR
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3238
Mailing Address - Country:US
Mailing Address - Phone:203-313-1418
Mailing Address - Fax:
Practice Address - Street 1:81 BOWMAN DR
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-3238
Practice Address - Country:US
Practice Address - Phone:203-313-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-09
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001727104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker