Provider Demographics
NPI:1417222902
Name:ROTHMAN, WENDY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ANN
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HALF MILE RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2523
Mailing Address - Country:US
Mailing Address - Phone:631-348-7772
Mailing Address - Fax:
Practice Address - Street 1:200 HALF MILE RD
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2523
Practice Address - Country:US
Practice Address - Phone:631-348-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013660103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool