Provider Demographics
NPI:1265459226
Name:ROTOLO, LORETTA (MA, RDT, LCAT)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:
Last Name:ROTOLO
Suffix:
Gender:F
Credentials:MA, RDT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-1315
Mailing Address - Country:US
Mailing Address - Phone:845-647-3349
Mailing Address - Fax:845-647-3352
Practice Address - Street 1:50 CENTER ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1315
Practice Address - Country:US
Practice Address - Phone:845-647-3349
Practice Address - Fax:845-647-3352
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY000894-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)