Healthcare Provider Details

I. General information

NPI: 1740905678
Provider Name (Legal Business Name): STEVEN ANDREW ROTH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 02/03/2024
Certification Date: 02/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S 620 W
OREM UT
84058-3324
US

IV. Provider business mailing address

784 S RIVER RIDGE LN
SPANISH FORK UT
84660-4712
US

V. Phone/Fax

Practice location:
  • Phone: 385-208-6197
  • Fax:
Mailing address:
  • Phone: 385-208-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12810555-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12810555-3501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: