Provider Demographics
NPI:1104048420
Name:ROTHMAN, LAURA JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:ROTHMAN-MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16125 AVALON WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1241
Mailing Address - Country:US
Mailing Address - Phone:609-298-4793
Mailing Address - Fax:209-298-9288
Practice Address - Street 1:410 FARNSWORTH AVENUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-0000
Practice Address - Country:US
Practice Address - Phone:609-298-4793
Practice Address - Fax:609-298-9288
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05005300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114860Medicare PIN