Provider Demographics
NPI:1003980376
Name:ROTHENBERG, AMY BETH (ND NATUROPATHIC DOCT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:ND NATUROPATHIC DOCT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:356 MIDDLE STREET
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:413-253-5011
Mailing Address - Fax:413-256-6223
Practice Address - Street 1:115 ELM STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-1225
Practice Address - Fax:860-253-5041
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000108175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
110000108CT01OtherBLUE CROSS BLUE SHIELD