Provider Demographics
NPI:1184192098
Name:BOLOTINA-ROZMAN, TATIANA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:
Last Name:BOLOTINA-ROZMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PAINTED WAGON RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2726
Mailing Address - Country:US
Mailing Address - Phone:815-505-4554
Mailing Address - Fax:732-526-2130
Practice Address - Street 1:6 CORNWALL CT STE B
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3347
Practice Address - Country:US
Practice Address - Phone:732-955-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06431800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health