Provider Demographics
NPI:1508259003
Name:ROTHHAAR, MARIA CATHERINE (PHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CATHERINE
Last Name:ROTHHAAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CATHERINE
Other - Last Name:GROSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:522 N NEW BALLAS RD STE 121
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6820
Mailing Address - Country:US
Mailing Address - Phone:314-391-6770
Mailing Address - Fax:
Practice Address - Street 1:522 N NEW BALLAS RD STE 121
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6820
Practice Address - Country:US
Practice Address - Phone:314-391-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015042889103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical