Provider Demographics
NPI:1104997394
Name:ROTHBART-MAYER, RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:ROTHBART-MAYER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2205
Mailing Address - Country:US
Mailing Address - Phone:973-731-7357
Mailing Address - Fax:
Practice Address - Street 1:441 W END AVE APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5327
Practice Address - Country:US
Practice Address - Phone:212-579-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0146471041C0700X
NJ44SC005357001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7404700OtherGHI
NYN2H741Medicare ID - Type Unspecified