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General NPI Number Information
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NPI Number | 1528368115
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Entity Type | Individual
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Provider Name | LAURA ROTH MSW, BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 278 N UNION ST SUITE 112
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City | LAMBERTVILLE
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State | NJ
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Zip | 08530-1506
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Country | US
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Telephone | 215-862-1315
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Fax | 999-999-9999
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Provider Business Mailing Address
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Address Line | 236 RIVERWOODS DR
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City | NEW HOPE
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State | PA
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Zip | 18938-2246
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Country | US
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Telephone | 215-862-1315
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00476300
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License Number State | NJ
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