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General NPI Number Information
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NPI Number | 1912593278
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Entity Type | Individual
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Provider Name | PATRICIA ROTH MA, LCAT, ATR-BC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 236 E 82ND ST APT 1F
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City | NEW YORK
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State | NY
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Zip | 10028-2798
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Country | US
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Telephone | 917-225-6216
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Fax |
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Provider Business Mailing Address
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Address Line | 2634 202ND ST
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City | BAYSIDE
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State | NY
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Zip | 11360-2325
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Country | US
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Telephone | 917-225-6216
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 001650-1
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License Number State | NY
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