Provider Demographics
NPI:1477531051
Name:ROTHMAN, ROGER CRAIG (LCSW)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CRAIG
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330B MCWHORTER PL
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-5605
Mailing Address - Country:US
Mailing Address - Phone:703-642-1112
Mailing Address - Fax:703-642-6082
Practice Address - Street 1:7330B MCWHORTER PL
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-5605
Practice Address - Country:US
Practice Address - Phone:703-642-1112
Practice Address - Fax:703-642-6082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3011041C0700X
MD28331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8901392Medicaid
786060Medicare ID - Type Unspecified