Provider Demographics
NPI:1750674610
Name:AMADOR, ROLANDO (L M S W)
Entity type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:
Last Name:AMADOR
Suffix:
Gender:M
Credentials:L M S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7106
Mailing Address - Country:US
Mailing Address - Phone:718-382-1060
Mailing Address - Fax:718-382-1449
Practice Address - Street 1:1520 E 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7106
Practice Address - Country:US
Practice Address - Phone:718-382-1060
Practice Address - Fax:718-382-1449
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0612670-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool