Provider Demographics
NPI:1578655023
Name:ROTTKAMP, DIANE MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:ROTTKAMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3908
Mailing Address - Country:US
Mailing Address - Phone:609-586-6485
Mailing Address - Fax:
Practice Address - Street 1:2300 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3007
Practice Address - Country:US
Practice Address - Phone:609-587-7044
Practice Address - Fax:609-587-6765
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00098800101YA0400X
NJ44SC00484001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)