Provider Demographics
NPI:1891269395
Name:ROTHENBERG-JAMES, KATHY (CDCA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:ROTHENBERG-JAMES
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 ST. CLAIR AVE., J .GLEN SMITH HEALTH CENTER
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108
Mailing Address - Country:US
Mailing Address - Phone:216-664-2362
Mailing Address - Fax:216-420-7744
Practice Address - Street 1:11100 ST. CLAIR AVE., J .GLEN SMITH HEALTH CENTER
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108
Practice Address - Country:US
Practice Address - Phone:216-664-2362
Practice Address - Fax:216-420-7744
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH169203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)