Healthcare Provider Details

I. General information

NPI: 1043739147
Provider Name (Legal Business Name): STEPHANIE MICHELL ROTHENBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W 7TH ST
FREDERICK MD
21701
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 730
GREENBELT MD
20770-3523
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-1022
  • Fax:
Mailing address:
  • Phone: 301-345-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: