Healthcare Provider Details

I. General information

NPI: 1487060869
Provider Name (Legal Business Name): CAROLYN TOBEY ROATH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 STAR FLOWER DR
HASLETT MI
48840-8695
US

IV. Provider business mailing address

5505 STAR FLOWER DR
HASLETT MI
48840-8695
US

V. Phone/Fax

Practice location:
  • Phone: 517-242-4426
  • Fax:
Mailing address:
  • Phone: 517-242-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095888
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801095888
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: