Provider Demographics
NPI:1023562428
Name:ROTKOWITZ, NANCY BETH (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BETH
Last Name:ROTKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WINDMERE DR
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-2702
Mailing Address - Country:US
Mailing Address - Phone:207-907-6897
Mailing Address - Fax:
Practice Address - Street 1:18 WINDMERE DR
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2702
Practice Address - Country:US
Practice Address - Phone:207-907-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22191041C0700X
MEMC16198104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMC16198OtherSOCIAL WORKER LICENSURE, STATE OF MAINE