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General NPI Number Information
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NPI Number | 1265489611
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Entity Type | Individual
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Provider Name | JOAN ROTH PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 BIALYSTOKER PL
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City | NEW YORK
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State | NY
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Zip | 10002-4008
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Country | US
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Telephone | 212-673-8500
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Fax | 212-353-9471
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Provider Business Mailing Address
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Address Line | 1 OLD COUNTRY RD SUITE 271
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City | CARLE PLACE
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State | NY
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Zip | 11514-1801
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Country | US
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Telephone | 800-725-6280
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Fax | 800-725-6380
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015838
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License Number State | NY
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