Provider Demographics
NPI:1790842342
Name:ROTMAN, ELLIOTT B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:B
Last Name:ROTMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 WALNUT ST STE 811
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5308
Mailing Address - Country:US
Mailing Address - Phone:215-731-1311
Mailing Address - Fax:215-731-1144
Practice Address - Street 1:1616 WALNUT ST STE 811
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5308
Practice Address - Country:US
Practice Address - Phone:215-731-1311
Practice Address - Fax:215-731-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003953-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical