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NPI Code Detail

MEDICARE: CASONDRA ROTH M.E.D

MEDICARE: CASONDRA ROTH M.E.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1437701133
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASONDRA ROTH M.E.D
Provider Business Mailing Address
First Line : 10 MECHANIC ST STE 302
Second Line :
City : WORCESTER
State : MA
Zip : 01608-2419
Country : US
Telephone Number : 508-792-5400
Fax Number : 508-831-0045
Provider Business Practice Location Address
First Line : 1274 CURRAN HWY
Second Line :
City : NORTH ADAMS
State : MA
Zip : 01247-3907
Country : US
Telephone Number : 413-664-9024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2019
Last Update Date : 07/12/2019

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