Provider Demographics
NPI:1205275047
Name:DEROCHE, JEFFREY MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:DEROCHE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 WASHINGTON PARK
Mailing Address - Street 2:APT. 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3234
Mailing Address - Country:US
Mailing Address - Phone:917-280-6440
Mailing Address - Fax:
Practice Address - Street 1:230 W 17TH ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5325
Practice Address - Country:US
Practice Address - Phone:212-271-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY73 0846741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical