Provider Demographics
NPI:1033155056
Name:ROTHBERG, MICHAEL L (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:ROTHBERG
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COUNTY RD
Mailing Address - Street 2:OFFICE #3
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2200
Mailing Address - Country:US
Mailing Address - Phone:201-906-9049
Mailing Address - Fax:212-645-3137
Practice Address - Street 1:155 COUNTY RD
Practice Address - Street 2:OFFICE #3
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2200
Practice Address - Country:US
Practice Address - Phone:201-906-9049
Practice Address - Fax:212-645-3137
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052229001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ305495OtherMHN
NJ72142700OtherMAGELLAN
NJ300235859OtherBLUE CROSS BLUE SHIELD
NJP3175428OtherOXFORD