Provider Demographics
NPI:1912151291
Name:ROTHENBERG, MARCI (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:MARCI
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:41 W 82ND ST
Mailing Address - Street 2:APT 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5610
Mailing Address - Country:US
Mailing Address - Phone:646-325-6334
Mailing Address - Fax:
Practice Address - Street 1:41 W 82ND ST
Practice Address - Street 2:APT 6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5610
Practice Address - Country:US
Practice Address - Phone:646-325-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015280-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist