Provider Demographics
NPI:1760418107
Name:RENTROP, CARLA BAUER (PHD)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:BAUER
Last Name:RENTROP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 35TH ST
Mailing Address - Street 2:FLOOR 7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2111
Mailing Address - Country:US
Mailing Address - Phone:212-475-8252
Mailing Address - Fax:212-475-8487
Practice Address - Street 1:131 W 35TH ST
Practice Address - Street 2:FLOOR 7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2111
Practice Address - Country:US
Practice Address - Phone:212-475-8252
Practice Address - Fax:212-475-8487
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV73101Medicare ID - Type Unspecified
NYR53704Medicare UPIN