Provider Demographics
NPI:1104913375
Name:ROTHENBERG, JUDITH S (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:S
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:S
Other - Last Name:ROTHENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:13199 SE SPYGLASS CT
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-7244
Mailing Address - Country:US
Mailing Address - Phone:772-284-4147
Mailing Address - Fax:772-545-3494
Practice Address - Street 1:1080 E INDIANTOWN RD
Practice Address - Street 2:SUITE. 104A
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5100
Practice Address - Country:US
Practice Address - Phone:772-284-4147
Practice Address - Fax:772-545-3494
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 50321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHE482AMedicare UPIN