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General NPI Number Information
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NPI Number | 1861617862
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Entity Type | Individual
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Provider Name | JUDITH SHARON ROTH PHD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 W END AVE
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City | NEW YORK
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State | NY
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Zip | 10024-5708
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Country | US
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Telephone | 212-877-8138
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Fax |
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Provider Business Mailing Address
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Address Line | 460 RIVERSIDE DR # 112
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City | NEW YORK
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State | NY
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Zip | 10027-6821
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Country | US
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Telephone | 212-877-8138
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 011385-1
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License Number State | NY
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