Provider Demographics
NPI:1548282882
Name:ROTHFELD, BEVERLY R (RN-CS, NP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:R
Last Name:ROTHFELD
Suffix:
Gender:F
Credentials:RN-CS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:STE 7D
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-277-8107
Mailing Address - Fax:617-734-6385
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:STE 7D
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-277-8107
Practice Address - Fax:617-734-6385
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152814363LP0808X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP5096Medicare ID - Type Unspecified