Provider Demographics
NPI:1245694694
Name:JOHNSON, ROCHELLE L (LSW)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BAYNARD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802
Mailing Address - Country:US
Mailing Address - Phone:732-803-5149
Mailing Address - Fax:
Practice Address - Street 1:2005 BAYNARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802
Practice Address - Country:US
Practice Address - Phone:302-943-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health