Provider Demographics
NPI:1326058942
Name:ROITGARTS, IRENA (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:IRENA
Middle Name:
Last Name:ROITGARTS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LAKEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2514
Mailing Address - Country:US
Mailing Address - Phone:917-748-0814
Mailing Address - Fax:
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4914
Practice Address - Country:US
Practice Address - Phone:917-748-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071633-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1417285610OtherORGANIZATION NPI
NYG100008691OtherGROUP PTAN
NYP66228Medicare UPIN