Provider Demographics
NPI:1538860184
Name:ROTENBERG MOSES, DEBORAH CAROL (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CAROL
Last Name:ROTENBERG MOSES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:CAROL
Other - Last Name:ROTENBERG MOSES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 W 63RD ST APT 14N
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7173
Mailing Address - Country:US
Mailing Address - Phone:347-909-2727
Mailing Address - Fax:917-591-8002
Practice Address - Street 1:30 W 63RD ST APT 14N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7173
Practice Address - Country:US
Practice Address - Phone:347-909-2727
Practice Address - Fax:917-591-8002
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR076839102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst