Provider Demographics
NPI:1538292313
Name:ROTHENBERG, JAMI LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMI
Middle Name:LYNN
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3701
Mailing Address - Country:US
Mailing Address - Phone:212-459-4328
Mailing Address - Fax:
Practice Address - Street 1:13 GAY ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3535
Practice Address - Country:US
Practice Address - Phone:212-459-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical