Provider Demographics
NPI:1457689085
Name:ROTTENBERG, ELIZABETH
Entity Type:Individual
Prefix:PROF
First Name:ELIZABETH
Middle Name:
Last Name:ROTTENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W JARVIS AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2040
Mailing Address - Country:US
Mailing Address - Phone:773-203-4058
Mailing Address - Fax:
Practice Address - Street 1:2352 N CLIFTON AVE
Practice Address - Street 2:SUITE 150.17
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3208
Practice Address - Country:US
Practice Address - Phone:773-325-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst