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General NPI Number Information
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NPI Number | 1134129307
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Entity Type | Individual
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Provider Name | KENNETH MICHAEL ROTHMAN D,ED.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 1061 E INDIANTOWN RD SUITE 311
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City | JUPITER
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State | FL
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Zip | 33477-5104
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Country | US
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Telephone | 561-575-0323
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Fax | 561-575-0323
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Provider Business Mailing Address
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Address Line | 1061 E INDIANTOWN RD SUITE 311
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City | JUPITER
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State | FL
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Zip | 33477-5104
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Country | US
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Telephone | 561-575-0323
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Fax | 561-575-0323
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY2560
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | PY2560
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License Number State | FL
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