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General NPI Number Information
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NPI Number | 1205128188
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Entity Type | Organization
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Legal Business Name | SCOTT A. ROTH, PSY.D., LLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 70 S MAIN ST SUITE 1A
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City | CRANBURY
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State | NJ
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Zip | 08512-3140
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Country | US
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Telephone | 609-217-0973
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Fax | 609-395-0886
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Provider Business Mailing Address
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Address Line | 70 S MAIN ST SUITE 1A
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City | CRANBURY
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State | NJ
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Zip | 08512-3140
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Country | US
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Telephone | 609-217-0973
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Fax | 609-395-0886
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. SCOTT AARON ROTH
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Credential | PSY.D.
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Telephone | 609-217-0973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00466700
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License Number State | NJ
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