Provider Demographics
NPI:1205991536
Name:ROTHMAN, FREDDA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:FREDDA
Middle Name:J
Last Name:ROTHMAN
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 1:56 CROOKED STICK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4035
Mailing Address - Country:US
Mailing Address - Phone:732-833-2082
Mailing Address - Fax:201-489-8172
Practice Address - Street 1:3186 RT. 27
Practice Address - Street 2:SUITE 201
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-940-2903
Practice Address - Fax:201-489-8172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047659001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37696Medicare ID - Type Unspecified