Provider Demographics
NPI:1033801766
Name:ROTHAR, ADRIENNE JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:JANE
Last Name:ROTHAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GRUMMAN RD. W
Mailing Address - Street 2:STE, 1000
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5028
Mailing Address - Country:US
Mailing Address - Phone:516-465-4700
Mailing Address - Fax:
Practice Address - Street 1:15 GRUMMAN RD. W
Practice Address - Street 2:STE, 1000
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5028
Practice Address - Country:US
Practice Address - Phone:516-465-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072288-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical