Healthcare Provider Details

I. General information

NPI: 1275140956
Provider Name (Legal Business Name): COLLABORATIVE PATHWAYS COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021A EMMORTON RD STE 210
BEL AIR MD
21015-8965
US

IV. Provider business mailing address

4509 FIELDGREEN RD
NOTTINGHAM MD
21236-1819
US

V. Phone/Fax

Practice location:
  • Phone: 443-595-7659
  • Fax:
Mailing address:
  • Phone: 443-595-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA R ROTHSTEIN
Title or Position: PSYCHOLOGIST/OWNER
Credential: PSY.D.
Phone: 443-595-7659