Provider Demographics
NPI:1881117232
Name:ROTHERMEL, GINA E (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:E
Last Name:ROTHERMEL
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 1:2153 E HAGERT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-2121
Mailing Address - Country:US
Mailing Address - Phone:267-467-3384
Mailing Address - Fax:
Practice Address - Street 1:300 E LANCASTER AVE STE 211
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2142
Practice Address - Country:US
Practice Address - Phone:267-467-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0195191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical