Provider Demographics
NPI:1184685125
Name:ROTHMAN, RICHARD A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GRANDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-8731
Mailing Address - Country:US
Mailing Address - Phone:973-868-3805
Mailing Address - Fax:
Practice Address - Street 1:918 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4142
Practice Address - Country:US
Practice Address - Phone:973-868-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC007792001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ210362OtherMHN
NJ959969OtherHEALTHNET
NJ042932Medicare PIN