Provider Demographics
NPI:1720322258
Name:CHAVEZ, ROCIO E (MA, MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:ROCIO
Middle Name:E
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:MA, MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 SKILLMAN AVE
Mailing Address - Street 2:APT. 2D
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 150TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1748
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:718-357-3251
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1073410103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst