Provider Demographics
NPI:1174736979
Name:ROTHERY, CHERYLL (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHERYLL
Middle Name:
Last Name:ROTHERY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2643
Mailing Address - Country:US
Mailing Address - Phone:215-248-7023
Mailing Address - Fax:215-753-3619
Practice Address - Street 1:1016 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-7703
Practice Address - Country:US
Practice Address - Phone:215-248-7023
Practice Address - Fax:215-753-3619
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008803L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical