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General NPI Number Information
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NPI Number | 1124840038
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Entity Type | Organization
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Legal Business Name | CHILDREN'S PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 9040 TOWN CENTER PKWY
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4101
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Country | US
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Telephone | 941-877-0284
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Fax |
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Provider Business Mailing Address
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Address Line | 9040 TOWN CENTER PKWY
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-4101
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Country | US
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Telephone | 941-877-0284
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. VALERIE ROTH
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Credential | PSY. D.
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Telephone | 941-877-0284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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