Basic Information
| Provider Information | |||||||||
| NPI: | 1891456729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROTHENBERG | ||||||||
| FirstName: | ARIELLE | ||||||||
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| Credential: | LMHC, ATR-P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 LOS ALTOS DE CICUYE | ||||||||
| Address2: | |||||||||
| City: | PECOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875522555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503809547 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2960 RODEO PARK DR W | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875056351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059869633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2022 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 221700000X | 22-031 | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 101YM0800X | T-CTL0221941 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.