Provider Demographics
NPI:1902160807
Name:LEVINE, ROCHELLE (MSED)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:GONGOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:4 WINSTON RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1435
Mailing Address - Country:US
Mailing Address - Phone:845-826-6079
Mailing Address - Fax:
Practice Address - Street 1:4 WINSTON RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1435
Practice Address - Country:US
Practice Address - Phone:845-826-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206769081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY206769081OtherNYS DEPARTMENT OF EDUCATION