Provider Demographics
NPI:1659548527
Name:PORT, ROCHELLE LEVINE (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LEVINE
Last Name:PORT
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CHESTER CT
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6360
Mailing Address - Country:US
Mailing Address - Phone:914-734-1217
Mailing Address - Fax:
Practice Address - Street 1:670 STONELEIGH AVE
Practice Address - Street 2:BUILDING 665 SUITE 205
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3997
Practice Address - Country:US
Practice Address - Phone:845-279-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000033-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400002891Medicare PIN