Provider Demographics
NPI:1982288759
Name:ROTOLO, TAYLOR (LCSW, ACHT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:ROTOLO
Suffix:
Gender:F
Credentials:LCSW, ACHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-0185
Mailing Address - Country:US
Mailing Address - Phone:484-998-0939
Mailing Address - Fax:
Practice Address - Street 1:638 NEWARK AVE # 4
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2306
Practice Address - Country:US
Practice Address - Phone:201-839-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06198200104100000X
PACW023161104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker