Provider Demographics
NPI:1861765232
Name:ROTHSTEIN, JESSICA ROSE
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ROSE
Last Name:ROTHSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2021A EMMORTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8965
Mailing Address - Country:US
Mailing Address - Phone:443-595-7659
Mailing Address - Fax:
Practice Address - Street 1:2021A EMMORTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8965
Practice Address - Country:US
Practice Address - Phone:443-595-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist