Provider Demographics
NPI:1588702518
Name:ROTHENBERG, BARRY (LICSW)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 N FARMS RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-4510
Mailing Address - Country:US
Mailing Address - Phone:413-586-4129
Mailing Address - Fax:
Practice Address - Street 1:10 CENTRAL ST
Practice Address - Street 2:SUITE 27
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2700
Practice Address - Country:US
Practice Address - Phone:413-739-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10253491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07108OtherBCBSMA
MAP20234Medicare ID - Type Unspecified