MEDICARE: MICHAEL L ROTHBERG MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05222900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	305495	OTHER	NJ	MHN
2	72142700	OTHER	NJ	MAGELLAN
3	300235859	OTHER	NJ	BLUE CROSS BLUE SHIELD
4	P3175428	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1033155056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L ROTHBERG MSW, LCSW

Provider Business Mailing Address
First Line	:	155 COUNTY RD
Second Line	:	OFFICE #3
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-2200
Country	:	US
Telephone Number	:	201-906-9049
Fax Number	:	212-645-3137

Provider Business Practice Location Address
First Line	:	155 COUNTY RD
Second Line	:	OFFICE #3
City	:	CRESSKILL
State	:	NJ
Zip	:	07626-2200
Country	:	US
Telephone Number	:	201-906-9049
Fax Number	:	212-645-3137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/03/2019

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