Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 1475 | GA |
NPI | 1023121050 |
---|---|
Provider Name | Barbara O. Rothbaum |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4623 | (02) | GA |