Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0302495 | NY |
NPI | 1063031946 |
---|---|
Provider Name | Dr. Gwen Rachel Gordon Rothschild |
First Address | Baldwin Place, NY 10505-2004 |
Second Address | Hartsdale, NY 10530-3574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 10/04/2020 |