Provider Demographics
NPI:1750406005
Name:ROTZIEN, MARY KATHRYN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHRYN
Last Name:ROTZIEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 N OAK KNOLL AVE
Mailing Address - Street 2:SUITE THREE
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4170
Mailing Address - Country:US
Mailing Address - Phone:626-796-7511
Mailing Address - Fax:818-495-3062
Practice Address - Street 1:181 N OAK KNOLL AVE
Practice Address - Street 2:SUITE THREE
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4170
Practice Address - Country:US
Practice Address - Phone:626-796-7511
Practice Address - Fax:818-495-3062
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical