Provider Demographics
NPI:1891456729
Name:ROTHENBERG, ARIELLE MARIA (MPS, LMHC, LPAT)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:MARIA
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:MPS, LMHC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-1408
Mailing Address - Country:US
Mailing Address - Phone:650-380-9547
Mailing Address - Fax:
Practice Address - Street 1:5 JUNIPER ROAD
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556
Practice Address - Country:US
Practice Address - Phone:650-380-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0225531101YM0800X
NMCTB-2024-0333221700000X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health