Provider Demographics
NPI:1760532329
Name:WORTMAN, ROCHELLE (MS)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:
Last Name:WORTMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2625
Mailing Address - Country:US
Mailing Address - Phone:954-303-6133
Mailing Address - Fax:954-961-7638
Practice Address - Street 1:150 A SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-475-1371
Practice Address - Fax:954-961-7638
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health