Provider Demographics
NPI:1114084233
Name:ROTHGEB, ILENE VICTORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ILENE
Middle Name:VICTORIA
Last Name:ROTHGEB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:ILENE
Other - Middle Name:VICTORIA
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 10172
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-3172
Mailing Address - Country:US
Mailing Address - Phone:340-774-6937
Mailing Address - Fax:
Practice Address - Street 1:10 NORRE GADE
Practice Address - Street 2:
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3172
Practice Address - Country:US
Practice Address - Phone:340-776-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI98-004PSY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI008-7689Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST