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General NPI Number Information
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NPI Number | 1225576960
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Entity Type | Organization
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Legal Business Name | JULIE ROTENHEBER, PSYD, LP, LLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 618 E 11 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48067-1962
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Country | US
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Telephone | 248-933-6668
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Fax |
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Provider Business Mailing Address
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Address Line | 618 E 11 MILE RD
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City | ROYAL OAK
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State | MI
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Zip | 48067-1962
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JULIE ROTENHEBER
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Credential | PSYD, LP,
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Telephone | 248-933-6668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 6301016076
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License Number State | MI
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