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NPI Code Detail

MEDICARE: ERIK G ROTH LCSW

MEDICARE: ERIK G ROTH LCSW
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
11041C0700XClinical Social WorkerLCSW-42753ID

General Provider Information

NPI Number : 1578803284
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIK G ROTH LCSW
Provider Business Mailing Address
First Line : 10096 W FAIRVIEW AVE STE 160
Second Line :
City : BOISE
State : ID
Zip : 83704-5004
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10096 W FAIRVIEW AVE STE 160
Second Line :
City : BOISE
State : ID
Zip : 83704-5004
Country : US
Telephone Number : 208-908-7882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2013
Last Update Date : 05/28/2025

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Directions to “ ERIK G ROTH LCSW” Practice Location

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