Provider Demographics
NPI:1417035932
Name:ROTHBERG, LESLIE SHERMAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SHERMAN
Last Name:ROTHBERG
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 1:61 DALTON WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5305
Mailing Address - Country:US
Mailing Address - Phone:215-738-8331
Mailing Address - Fax:215-579-2639
Practice Address - Street 1:61 DALTON WAY
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-5305
Practice Address - Country:US
Practice Address - Phone:215-738-8331
Practice Address - Fax:215-579-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical