Provider Demographics
NPI:1851674063
Name:ROTHBERG, ANDREA C (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:ROTHBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:TEIXEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:70 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5094
Mailing Address - Country:US
Mailing Address - Phone:603-766-0613
Mailing Address - Fax:603-883-0007
Practice Address - Street 1:70 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5094
Practice Address - Country:US
Practice Address - Phone:603-766-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH217106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid