Provider Demographics
NPI:1053457051
Name:ROTOLO, LINDA BUTTELMAN (RLCSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BUTTELMAN
Last Name:ROTOLO
Suffix:
Gender:F
Credentials:RLCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:BUTTLEMAN ROTOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:44 CANNON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741
Mailing Address - Country:US
Mailing Address - Phone:631-338-5836
Mailing Address - Fax:
Practice Address - Street 1:44 CANNON DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-338-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05395711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical