Healthcare Provider Details

I. General information

NPI: 1114084233
Provider Name (Legal Business Name): ILENE VICTORIA ROTHGEB PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ILENE VICTORIA FROST PH.D.

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORRE GADE
ST. THOMAS VI
00802-3172
US

IV. Provider business mailing address

PO BOX 10172
ST THOMAS VI
00801-3172
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-3653
  • Fax:
Mailing address:
  • Phone: 340-774-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number98-004PSY
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: