Provider Demographics
NPI:1962657312
Name:ROTHBERG, CHERYL A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:ROTHBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-2305
Mailing Address - Country:US
Mailing Address - Phone:914-552-6680
Mailing Address - Fax:914-231-6513
Practice Address - Street 1:50 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-2305
Practice Address - Country:US
Practice Address - Phone:914-552-6680
Practice Address - Fax:914-231-6513
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-27
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-023879-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health