Provider Demographics
NPI:1801877386
Name:ROTHBAUM, ROCHELLE
Entity type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:
Last Name:ROTHBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:ROTHBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:294 RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2305
Mailing Address - Country:US
Mailing Address - Phone:845-362-3012
Mailing Address - Fax:
Practice Address - Street 1:294 RICHARD CT
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2305
Practice Address - Country:US
Practice Address - Phone:845-362-3012
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO322811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical