Provider Demographics
NPI:1285854224
Name:ROTHSTEIN, ROBERTA TERRY (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:TERRY
Last Name:ROTHSTEIN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PENNSYLVANIA AVE NW
Mailing Address - Street 2:602
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3405
Mailing Address - Country:US
Mailing Address - Phone:202-785-0035
Mailing Address - Fax:
Practice Address - Street 1:1901 PENNSYLVANIA AVE NW
Practice Address - Street 2:602
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3405
Practice Address - Country:US
Practice Address - Phone:202-785-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3021111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0432OtherBCBS PROVIDER NO.