MEDICARE: ROTTENBERG PSYCHOTHERAPY MENTAL HEALTH COUNSELING PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245845726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROTTENBERG PSYCHOTHERAPY MENTAL HEALTH COUNSELING PLLC

Provider Business Mailing Address
First Line	:	245 W 29TH ST RM 304
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-5208
Country	:	US
Telephone Number	:	203-518-4177
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 W 29TH ST RM 304
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-5208
Country	:	US
Telephone Number	:	203-518-4177
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA ROTTENBERG
Credential	:	LMHC
Telephone Number	:	203-518-4177

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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