Provider Demographics
NPI:1174342984
Name:ROCKLEIN, CONSTANCE (CARC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:ROCKLEIN
Suffix:
Gender:F
Credentials:CARC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51-01 39TH AVENUE
Mailing Address - Street 2:L41
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104
Mailing Address - Country:US
Mailing Address - Phone:347-456-4564
Mailing Address - Fax:
Practice Address - Street 1:51-01 39TH AVENUE
Practice Address - Street 2:L41
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:347-456-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCARC-3951171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach