Healthcare Provider Details

I. General information

NPI: 1336459478
Provider Name (Legal Business Name): RYAN REBECCA ROTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BEAUFORT ROAD
HAVELOCK NC
28532
US

IV. Provider business mailing address

200 WALKERS CAY CT
CEDAR POINT NC
28584-8104
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012222
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9780
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: