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NPI Code Detail

MEDICARE: MS. NANCY LYNN ROTH MA

MEDICARE: MS. NANCY LYNN ROTH MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1073830592
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY LYNN ROTH MA
Provider Business Mailing Address
First Line : 1407 RHAWN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-2803
Country : US
Telephone Number : 215-694-7172
Fax Number :
Provider Business Practice Location Address
First Line : 1407 RHAWN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-2803
Country : US
Telephone Number : 215-694-7172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2010
Last Update Date : 04/23/2010

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