MEDICARE: DR. ALYSSA K ROTHENBERG PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY 8720	FL

General Provider Information

NPI Number	:	1659715522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSSA K ROTHENBERG PSY.D.

Provider Business Mailing Address
First Line	:	5151 COLLINS AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2737
Country	:	US
Telephone Number	:	305-866-3579
Fax Number	:

Provider Business Practice Location Address
First Line	:	5151 COLLINS AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2737
Country	:	US
Telephone Number	:	305-866-3579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	11/08/2013

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