Provider Demographics
NPI:1366018459
Name:ROTBERG, MIRIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:ROTBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5027
Mailing Address - Country:US
Mailing Address - Phone:732-367-0975
Mailing Address - Fax:
Practice Address - Street 1:4 JESSICA CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5027
Practice Address - Country:US
Practice Address - Phone:732-367-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057977001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical