Provider Demographics
NPI:1952501728
Name:WERTENTEIL-ROTSTEIN, TINA (LCSWR)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WERTENTEIL-ROTSTEIN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 NORTH SERVICE RD LIE
Mailing Address - Street 2:NORTH SHORE CHILD GUIDANCE CENTER RFTS
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-484-3174
Mailing Address - Fax:516-484-2729
Practice Address - Street 1:80 NORTH SERVICE RD LIE
Practice Address - Street 2:NORTH SHORE CHILD GUIDANCE CENTER RFTS
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-484-3174
Practice Address - Fax:516-484-2729
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO73430-1R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical