Provider Demographics
NPI:1033135090
Name:ROTTENBERG, LEE S (MA, CRC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:S
Last Name:ROTTENBERG
Suffix:
Gender:M
Credentials:MA, CRC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60-27 77 STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-5248
Mailing Address - Country:US
Mailing Address - Phone:718-446-7257
Mailing Address - Fax:
Practice Address - Street 1:60-27 77 STREET
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-5248
Practice Address - Country:US
Practice Address - Phone:718-446-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional