Provider Demographics
NPI:1003358326
Name:ROTONDO, REBECCA (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROTONDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MAIN STREET EXTENSION
Mailing Address - Street 2:ACT TEAM, GILEAD COMMUNITY SERVICES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-343-5300
Mailing Address - Fax:
Practice Address - Street 1:230 MAIN STREET EXTENSION
Practice Address - Street 2:ACT TEAM, GILEAD COMMUNITY SERVICES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-343-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0013701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical