Provider Demographics
NPI:1245691484
Name:SHAIN, ROCHEL
Entity type:Individual
Prefix:
First Name:ROCHEL
Middle Name:
Last Name:SHAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROCHEL
Other - Middle Name:
Other - Last Name:JACOBOVITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 EDISON CT
Mailing Address - Street 2:APT D
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1952
Mailing Address - Country:US
Mailing Address - Phone:347-628-7512
Mailing Address - Fax:
Practice Address - Street 1:1133 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4811
Practice Address - Country:US
Practice Address - Phone:347-628-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002007103K00000X
NY955951151174400000X
NY822029141174400000X
NY955950151174400000X
NY002007-01103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist