=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639606825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIAM ROTHFRITZ, PH.D. AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2017
-----------------------------------------------------
Last Update Date | 06/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1135 CLIFTON AVE STE 103
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-3643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-978-7188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1135 CLIFTON AVE STE 207
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07013-3643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-988-4241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARIAM ROTHFRITZ
-----------------------------------------------------
Credential | PSYCHOLOGIST
-----------------------------------------------------
Telephone | 973-978-7188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35SI00496700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------