Healthcare Provider Details

I. General information

NPI: 1467539403
Provider Name (Legal Business Name): SELMA ROTHSTEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 STILLWATER AVE
MASSAPEQUA NY
11758-8420
US

IV. Provider business mailing address

91 STILLWATER AVE
MASSAPEQUA NY
11758-8420
US

V. Phone/Fax

Practice location:
  • Phone: 516-541-1442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number043776-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: