Provider Demographics
NPI:1710313077
Name:ROTHSTEIN, ESTEE K (MS BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ESTEE
Middle Name:K
Last Name:ROTHSTEIN
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4968
Mailing Address - Country:US
Mailing Address - Phone:732-886-9055
Mailing Address - Fax:
Practice Address - Street 1:1776 AVENUE OF THE STATES STE 101A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4592
Practice Address - Country:US
Practice Address - Phone:732-730-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-13741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst