MEDICARE: MRS. WENDY REISS ROTHFIELD 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	SW0000037	FL

General Provider Information

NPI Number	:	1568581130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY REISS ROTHFIELD MSW LCSW

Provider Business Mailing Address
First Line	:	2000 ISLAND BLVD
Second Line	:	WILLIAMS ISLAND
City	:	AVENTURA
State	:	FL
Zip	:	33160
Country	:	US
Telephone Number	:	305-932-5100
Fax Number	:	305-932-5678

Provider Business Practice Location Address
First Line	:	7150 W 20 AVE
Second Line	:	#315
City	:	HIALEAH
State	:	FL
Zip	:	33016
Country	:	US
Telephone Number	:	305-932-5100
Fax Number	:	305-932-5678

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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