Healthcare Provider Details

I. General information

NPI: 1578655023
Provider Name (Legal Business Name): DIANE MARIE ROTTKAMP LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DIANE MARIE WRIGHT

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAMILTON AVE
HAMILTON NJ
08619-3007
US

IV. Provider business mailing address

21 MATTHEW DR
HAMILTON SQUARE NJ
08690-3908
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-7044
  • Fax: 609-587-6765
Mailing address:
  • Phone: 609-586-6485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00098800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC0048400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: