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General NPI Number Information
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NPI Number | 1558569285
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Entity Type | Individual
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Provider Name | ABIGAIL ROTHENBERG LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 118 SPRING ST
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1817
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Country | US
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Telephone | 631-844-5651
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Fax | 631-844-5641
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Provider Business Mailing Address
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Address Line | 42 PROVINCE DR
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-4617
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Country | US
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Telephone | 631-495-2205
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 098883
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 067472
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License Number State | NY
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