Active NPI
Beanne O'Neill Rothenberg, PH.D.
- Clinical Psychologist
- Boulder, CO
National Provider Identifier
1760418180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3613
- Practice address
- 895 Aurora Ave
Boulder, CO 80302-7109 - Phone
- (315) 882-3371
- NPI assigned
- Jun 25, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 011228-1 | NY | |
| Clinical Psychologist | 103TC0700X | 3613 | CO | Primary |
Addresses
Primary practice location
895 Aurora Ave
Boulder, CO 80302-7109
Mailing address
895 Aurora Ave
Boulder, CO 80302-7109
Phone (315) 882-3371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3613 | Other | CO | PROFESSIONAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011228-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390435200000",
"number": "1760418180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "895 AURORA AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803027109",
"telephone_number": "315-882-3371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "895 AURORA AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803027109",
"telephone_number": "315-882-3371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTHENBERG",
"first_name": "BEANNE",
"middle_name": "O'NEILL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-25",
"last_updated": "2014-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "011228-1",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3613",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "3613",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.