=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821972357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. HALEY ROTTENBERG PSYCHOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 CLAREMONT AVE
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-704-2539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 CLAREMONT AVE
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-704-2539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. HALEY ROTTENBERG
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 484-704-2539
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------