Provider Demographics
NPI:1518334416
Name:ROTTENBERG, LESLIE ALLISON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ALLISON
Last Name:ROTTENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 QUEENS BLVD
Mailing Address - Street 2:ESPRIT MEDICAL CARE
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5776
Mailing Address - Country:US
Mailing Address - Phone:212-609-4011
Mailing Address - Fax:
Practice Address - Street 1:6110 QUEENS BLVD
Practice Address - Street 2:ESPRIT MEDICAL CARE
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5776
Practice Address - Country:US
Practice Address - Phone:212-609-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0545461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical