Provider Demographics
NPI:1972708121
Name:DIMOTTA, RODNEY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:J
Last Name:DIMOTTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SUGAR TOMS LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1150
Mailing Address - Country:US
Mailing Address - Phone:516-922-3490
Mailing Address - Fax:
Practice Address - Street 1:46 SUGAR TOMS LN
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1150
Practice Address - Country:US
Practice Address - Phone:516-922-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006927103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral