Provider Demographics
NPI:1568581130
Name:ROTHFIELD, WENDY REISS (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:REISS
Last Name:ROTHFIELD
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ISLAND BLVD
Mailing Address - Street 2:WILLIAMS ISLAND
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-932-5100
Mailing Address - Fax:305-932-5678
Practice Address - Street 1:7150 W 20 AVE
Practice Address - Street 2:#315
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-932-5100
Practice Address - Fax:305-932-5678
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00000371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4327Medicare ID - Type Unspecified