Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6301007114 | MI |
N | 103T00000X | Psychologist | 6301007114 | MI |
N | 103TS0200X | School Psychologist | 139703 | MI |
NPI | 1033251384 |
---|---|
Provider Name | Dr. Debora Ilene Rothbart |
First Address | Oak Park, MI 48237-1029 |
Second Address | Oak Park, MI 48237-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |