Provider Demographics
NPI:1962733907
Name:ROTHENBERG, RICHARD IAN (PSYD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:IAN
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:PSYD
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 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3107
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:7162 READING RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3838
Practice Address - Country:US
Practice Address - Phone:513-761-6222
Practice Address - Fax:513-679-4590
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
OH6965103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent