Provider Demographics
NPI:1366434045
Name:ROTHMAN, STUART PHILIP (LCSW, BCD)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:PHILIP
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 NORTH ST.
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2144
Mailing Address - Country:US
Mailing Address - Phone:814-337-8868
Mailing Address - Fax:814-333-1025
Practice Address - Street 1:1012 WATER ST.
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3444
Practice Address - Country:US
Practice Address - Phone:814-337-8868
Practice Address - Fax:814-333-1025
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-001051-L1041C0700X
PACW-001015-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0075448820003Medicaid
PA0075448820Medicaid
PARO645296TYPE56Medicare PIN
PARO645296Medicare ID - Type UnspecifiedPROVIDER NUMBER