Provider Demographics
NPI:1902186794
Name:ROTHBAUM, MELISSA BROOKE
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BROOKE
Last Name:ROTHBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 54TH ST APT 26M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4724
Mailing Address - Country:US
Mailing Address - Phone:201-410-5267
Mailing Address - Fax:
Practice Address - Street 1:245 E 54TH ST APT 26M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4724
Practice Address - Country:US
Practice Address - Phone:201-410-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst