Basic Information
| Provider Information | |||||||||
| NPI: | 1962855171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELK | ||||||||
| FirstName: | ROCHELLE | ||||||||
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| Credential: | MED, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1613 COOPERS WAY | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217019342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7605008700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5004 HONEYGO CENTER DR | ||||||||
| Address2: | STE 102-115 | ||||||||
| City: | PERRY HALL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211288963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883445977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-21387 | MD | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.