Provider Demographics
NPI:1114255379
Name:ROTENBERG, YAEL LAYA (LMHC)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:LAYA
Last Name:ROTENBERG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 QUENTIN RD
Mailing Address - Street 2:APT. 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2370
Mailing Address - Country:US
Mailing Address - Phone:305-467-0109
Mailing Address - Fax:
Practice Address - Street 1:2925A KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1805
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP73745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health