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General NPI Number Information
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NPI Number | 1063031946
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Entity Type | Individual
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Provider Name | GWEN RACHEL GORDON ROTHSCHILD PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 250 E HARTSDALE AVE STE 23
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City | HARTSDALE
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State | NY
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Zip | 10530-3574
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Country | US
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Telephone | 914-262-6646
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Fax |
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Provider Business Mailing Address
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Address Line | 77 TRAVIS RD
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City | BALDWIN PLACE
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State | NY
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Zip | 10505-2004
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Country | US
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Telephone | 914-262-6646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 0302495
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License Number State | NY
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