Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | RO45127-1 | NY |
NPI | 1003012337 |
---|---|
Provider Name | Ms. Debra Roth |
First Address | New York, NY 10003-4900 |
Second Address | New York, NY 10003-4564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2007 |
Last Update Date | 08/07/2007 |