Provider Demographics
NPI:1285932574
Name:ROTHMAN, ALLISON MARLA (PHD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARLA
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 12TH ST APT 4R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8242
Mailing Address - Country:US
Mailing Address - Phone:917-628-8516
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST RM 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4560
Practice Address - Country:US
Practice Address - Phone:917-628-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018831-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist