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NPI Code Detail

MEDICARE: ELLEN ROTTERSMANN LICSW

MEDICARE: ELLEN ROTTERSMANN LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1026208MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093884306
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN ROTTERSMANN LICSW
Provider Business Mailing Address
First Line : 3464 WASHINGTON ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2665
Country : US
Telephone Number : 617-320-0647
Fax Number :
Provider Business Practice Location Address
First Line : 3464 WASHINGTON ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2665
Country : US
Telephone Number : 617-320-0647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 09/05/2012

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Directions to “ ELLEN ROTTERSMANN LICSW” Practice Location

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