Provider Demographics
NPI:1578763801
Name:ROTHSCHILD, MARK ALAN (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:ROTHSCHILD
Suffix:
Gender:M
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 MONTGOMERY AVE
Mailing Address - Street 2:F4
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1753
Mailing Address - Country:US
Mailing Address - Phone:610-771-0535
Mailing Address - Fax:610-771-0535
Practice Address - Street 1:1334 MONTGOMERY AVE
Practice Address - Street 2:F4
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1753
Practice Address - Country:US
Practice Address - Phone:610-771-0535
Practice Address - Fax:610-771-0535
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005901E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical