Provider Demographics
NPI:1952455826
Name:ROTHFARB, HERBERT IVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:IVAN
Last Name:ROTHFARB
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 1:215 PLEASANT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3018
Mailing Address - Country:US
Mailing Address - Phone:508-673-0064
Mailing Address - Fax:508-673-3223
Practice Address - Street 1:215 PLEASANT ST STE 4
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3018
Practice Address - Country:US
Practice Address - Phone:508-673-0064
Practice Address - Fax:508-673-3223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2012103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAR04482Medicare UPIN