Provider Demographics
NPI:1811106479
Name:ROTHBERG, NEIL M (MA, CASAC)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:M
Last Name:ROTHBERG
Suffix:
Gender:M
Credentials:MA, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2533
Mailing Address - Country:US
Mailing Address - Phone:516-536-5658
Mailing Address - Fax:
Practice Address - Street 1:298 N FOREST AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2533
Practice Address - Country:US
Practice Address - Phone:516-536-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist