MEDICARE: BARRY ROTHENBERG LICSW

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	1025349	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P07108	OTHER	MA	BCBSMA

General Provider Information

NPI Number	:	1588702518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY ROTHENBERG LICSW

Provider Business Mailing Address
First Line	:	489 N FARMS RD
Second Line	:
City	:	FLORENCE
State	:	MA
Zip	:	01062-4510
Country	:	US
Telephone Number	:	413-586-4129
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 CENTRAL ST
Second Line	:	SUITE 27
City	:	W SPRINGFIELD
State	:	MA
Zip	:	01089-2700
Country	:	US
Telephone Number	:	413-739-0712
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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Directions to “ BARRY ROTHENBERG LICSW” Practice Location

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