Active NPI
Daniela Rothenberg
- Mental Health Counselor
- Glendale, AZ
National Provider Identifier
1417430778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 17104
- Practice address
- 17505 N 79TH Ave
Glendale, AZ 85308-8725 - Phone
- (602) 800-7980
- NPI assigned
- Sep 12, 2018
- Last updated
- Sep 12, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 17104 | AZ | Primary |
Addresses
Primary practice location
17505 N 79TH Ave
Glendale, AZ 85308-8725
Mailing address
5616 W Andrea Dr
Phoenix, AZ 85083-7340
Phone (623) 518-4288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17104 | AZ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536710400000",
"number": "1417430778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5616 W ANDREA DR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850837340",
"telephone_number": "623-518-4288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17505 N 79TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853088725",
"telephone_number": "602-800-7980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTHENBERG",
"first_name": "DANIELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-12",
"last_updated": "2018-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AZ",
"license": "17104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.