Provider Demographics
NPI:1306927561
Name:ROTAS, GENA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:MARIE
Last Name:ROTAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BAYMOR DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2211
Mailing Address - Country:US
Mailing Address - Phone:413-626-6528
Mailing Address - Fax:413-525-5905
Practice Address - Street 1:39 BAYMOR DR
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2211
Practice Address - Country:US
Practice Address - Phone:413-626-6528
Practice Address - Fax:413-525-5905
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10293561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08009OtherBLUECROSSBLUESHIELD