Provider Demographics
NPI:1598944860
Name:ROTE, MARY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:ROTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 DEXTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2444
Mailing Address - Country:US
Mailing Address - Phone:814-825-2930
Mailing Address - Fax:814-825-2964
Practice Address - Street 1:4320 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2444
Practice Address - Country:US
Practice Address - Phone:814-825-2930
Practice Address - Fax:814-825-2964
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC000522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)