Healthcare Provider Details

I. General information

NPI: 1629102793
Provider Name (Legal Business Name): CYDNY ELAINE ROTHE M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 N OAK KNOLL AVE STE 4
PASADENA CA
91101-4174
US

IV. Provider business mailing address

181 N OAK KNOLL AVE STE 4
PASADENA CA
91101-4174
US

V. Phone/Fax

Practice location:
  • Phone: 323-664-9217
  • Fax: 323-661-8942
Mailing address:
  • Phone: 323-664-9217
  • Fax: 323-661-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS5212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: