Provider Demographics
NPI:1306231451
Name:ROTHMAN, SHANDI (LISW)
Entity Type:Individual
Prefix:
First Name:SHANDI
Middle Name:
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:SHANDI
Other - Middle Name:
Other - Last Name:OLMINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:5982 RHODES RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4128
Mailing Address - Country:US
Mailing Address - Phone:330-673-1347
Mailing Address - Fax:330-678-3677
Practice Address - Street 1:169 5TH ST SE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-9003
Practice Address - Country:US
Practice Address - Phone:330-379-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14512431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical