Healthcare Provider Details

I. General information

NPI: 1518720663
Provider Name (Legal Business Name): AMY L ROTH DSW, LSW, SSW, HSV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MANHEIM PIKE
LANCASTER PA
17601-3064
US

IV. Provider business mailing address

2986 KINGS LN
LANCASTER PA
17601-1617
US

V. Phone/Fax

Practice location:
  • Phone: 717-435-9687
  • Fax: 717-490-6117
Mailing address:
  • Phone: 717-598-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026483
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: