Provider Demographics
NPI:1831432673
Name:MASSROCK, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MASSROCK
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 1:202B GLENWOOD AVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202B GLENWOOD AVE
Practice Address - Street 2:APT 2E
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1348
Practice Address - Country:US
Practice Address - Phone:845-597-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017349-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist