Provider Demographics
NPI:1558569285
Name:SIROTA, ABIGAIL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:SIROTA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:ROTHENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:186 ERIK DR
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6424
Mailing Address - Country:US
Mailing Address - Phone:631-828-2185
Mailing Address - Fax:
Practice Address - Street 1:480 OLD WESTBURY RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2215
Practice Address - Country:US
Practice Address - Phone:516-299-5373
Practice Address - Fax:516-299-5293
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0674721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical