MEDICARE: MARIA K. ROTH

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.021325	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699275834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA K. ROTH

Provider Business Mailing Address
First Line	:	6460 HARRISON AVE STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7958
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	6460 HARRISON AVE STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7958
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	12/04/2024

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