Provider Demographics
NPI:1174748891
Name:ROTHBAUM, PEGGY ANN (PHD)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:ROTHBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SAINT PAUL STREET
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5112
Mailing Address - Country:US
Mailing Address - Phone:908-232-6233
Mailing Address - Fax:
Practice Address - Street 1:232 SAINT PAUL STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-5112
Practice Address - Country:US
Practice Address - Phone:908-232-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100292700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist