Provider Demographics
NPI:1275571390
Name:ROTHERMEL, ROBERT D (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:ROTHERMEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:BOX 137
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-4879
Mailing Address - Fax:313-993-0282
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:UHC 4B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4879
Practice Address - Fax:313-993-0282
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301005645103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist