Provider Demographics
NPI:1124273644
Name:ROTHEN, RICHARD (FP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ROTHEN
Suffix:
Gender:M
Credentials:FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8432 E SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6761
Mailing Address - Country:US
Mailing Address - Phone:602-577-7542
Mailing Address - Fax:
Practice Address - Street 1:8432 E SAN MIGUEL AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6761
Practice Address - Country:US
Practice Address - Phone:602-577-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9520Medicaid