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NPI Code Detail

MEDICARE: ROBERT E ROTH PSYD

MEDICARE: ROBERT E ROTH PSYD
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
1103TC0700XClinical PsychologistTN

General Provider Information

NPI Number : 1679593040
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT E ROTH PSYD
Provider Business Mailing Address
First Line : 2333 KNOB CREEK RD
Second Line : SUITE 11
City : JOHNSON CITY
State : TN
Zip : 37604-2007
Country : US
Telephone Number : 423-952-0500
Fax Number : 423-950-0005
Provider Business Practice Location Address
First Line : 2333 KNOB CREEK RD
Second Line : SUITE 11
City : JOHNSON CITY
State : TN
Zip : 37604-2007
Country : US
Telephone Number : 423-952-0500
Fax Number : 423-950-0005
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT ERIC ROTH
Credential : PSYD
Telephone Number : 423-952-0500
Provider Enumeration Date : 07/20/2006
Last Update Date : 08/22/2020

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Directions to “ROBERT E ROTH PSYD ” Practice Location

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