Provider Demographics
NPI:1376784165
Name:ROLLET, CHRISTINE GABRIELLE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:GABRIELLE
Last Name:ROLLET
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E 30TH ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6430
Mailing Address - Country:US
Mailing Address - Phone:917-680-3745
Mailing Address - Fax:212-679-6107
Practice Address - Street 1:286 5TH AVE FL 10G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4512
Practice Address - Country:US
Practice Address - Phone:917-680-3745
Practice Address - Fax:212-679-6107
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0710091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331071579OtherEIN NUMBER