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General NPI Number Information
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NPI Number | 1801806278
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Entity Type | Individual
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Provider Name | KATHLEEN DENISE ROTH LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 459 PATTERSON ROAD DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH SERVICES
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 808-433-0609
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Fax |
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Provider Business Mailing Address
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Address Line | 2916 DATE ST. 10-D
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City | HONOLULU
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State | HI
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Zip | 96816
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Country | US
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Telephone | 808-734-2337
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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 | LCSW 3024
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License Number State | HI
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