Provider Demographics
NPI:1669244703
Name:LAROCK, CATHERINE SUSAN
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUSAN
Last Name:LAROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W FALLS RD
Mailing Address - Street 2:
Mailing Address - City:WEST FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14170-9715
Mailing Address - Country:US
Mailing Address - Phone:315-529-5121
Mailing Address - Fax:
Practice Address - Street 1:111 W FALLS RD
Practice Address - Street 2:
Practice Address - City:WEST FALLS
Practice Address - State:NY
Practice Address - Zip Code:14170-9715
Practice Address - Country:US
Practice Address - Phone:315-529-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576504-01163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care