Provider Demographics
NPI:1033251384
Name:ROTHBART, DEBORA ILENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:ILENE
Last Name:ROTHBART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26031 STRATFORD PL
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1029
Mailing Address - Country:US
Mailing Address - Phone:248-968-1162
Mailing Address - Fax:248-968-1162
Practice Address - Street 1:26031 STRATFORD PL
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1029
Practice Address - Country:US
Practice Address - Phone:248-968-1162
Practice Address - Fax:248-968-1162
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007114103T00000X
MI139703103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool