Basic Information
Provider Information | |||||||||
NPI: | 1699957795 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GIOVANNINI | ||||||||
FirstName: | ROCHELLE | ||||||||
MiddleName: | GIOVANNINI | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.M.H.C. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REYNHOUT | ||||||||
OtherFirstName: | ROCHELLE | ||||||||
OtherMiddleName: | GIOVANNINI | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1639 FORUM PL STE 7 | ||||||||
Address2: |   | ||||||||
City: | WEST PALM BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 334012330 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617128821 | ||||||||
FaxNumber: | 5617128070 | ||||||||
Practice Location | |||||||||
Address1: | 1639 FORUM PL STE 7 | ||||||||
Address2: |   | ||||||||
City: | WEST PALM BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 334012330 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5617128821 | ||||||||
FaxNumber: | 5617128070 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/29/2007 | ||||||||
LastUpdateDate: | 08/06/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH7580 | FL | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 766216500 | 05 | FL |   | MEDICAID |