Provider Demographics
NPI:1356821664
Name:ROTHENBERG, ANNE (LMHC, PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:LMHC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LEE RD STE 219
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1863
Mailing Address - Country:US
Mailing Address - Phone:407-797-5468
Mailing Address - Fax:
Practice Address - Street 1:1950 LEE RD STE 219
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1863
Practice Address - Country:US
Practice Address - Phone:407-797-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health