Provider Demographics
NPI:1346748126
Name:ROTHENBERG, JOSHUA SAMUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:SAMUEL
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14692
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-0692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1008 GENERAL KENNEDY AVE STE 106
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-1729
Practice Address - Country:US
Practice Address - Phone:415-894-5327
Practice Address - Fax:415-465-7543
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical