Healthcare Provider Details

I. General information

NPI: 1992735328
Provider Name (Legal Business Name): BARBARA R. ROTH LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 RIDGELYS CHOICE DR SUITE 105
BALTIMORE MD
21236-3026
US

IV. Provider business mailing address

8615 RIDGELYS CHOICE DR SUITE 105
BALTIMORE MD
21236-3026
US

V. Phone/Fax

Practice location:
  • Phone: 410-256-3200
  • Fax: 410-529-2462
Mailing address:
  • Phone: 410-256-3200
  • Fax: 410-529-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06089
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: