Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 000108 | CT |
NPI | 1003980376 |
---|---|
Provider Name | Amy Beth Rothenberg |
First Address | Amherst, MA 01002 |
Second Address | Enfield, CT 06082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110000108CT01 | BLUE CROSS BLUE SHIELD (01) |