Provider Demographics
NPI:1003131145
Name:SULICHIN ROTSZTAIN, PATRICIA S (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:S
Last Name:SULICHIN ROTSZTAIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 NE 192ND ST PH LP4
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2460
Mailing Address - Country:US
Mailing Address - Phone:786-251-9513
Mailing Address - Fax:
Practice Address - Street 1:2385 NW EXECUTIVE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8510
Practice Address - Country:US
Practice Address - Phone:786-251-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health