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NPI Code Detail

MEDICARE: MRS. ABIGAIL ROTHENBERG LCSW

MEDICARE: MRS. ABIGAIL ROTHENBERG 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
11041C0700XClinical Social Worker098883NY
21041C0700XClinical Social Worker067472NY

General Provider Information

NPI Number : 1558569285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ABIGAIL ROTHENBERG LCSW
Provider Business Mailing Address
First Line : 42 PROVINCE DR
Second Line :
City : SOUTH SETAUKET
State : NY
Zip : 11720-4617
Country : US
Telephone Number : 631-495-2205
Fax Number :
Provider Business Practice Location Address
First Line : 118 SPRING ST
Second Line :
City : PORT JEFFERSON
State : NY
Zip : 11777-1817
Country : US
Telephone Number : 631-844-5651
Fax Number : 631-844-5641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/14/2025

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