Provider Demographics
NPI:1629276738
Name:ROTHSTEIN, MARY NELLY (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:NELLY
Last Name:ROTHSTEIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 WOODLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5913
Mailing Address - Country:US
Mailing Address - Phone:216-939-3729
Mailing Address - Fax:216-631-3561
Practice Address - Street 1:7800 DETROIT AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102
Practice Address - Country:US
Practice Address - Phone:216-939-3729
Practice Address - Fax:216-631-3561
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002674101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional