MEDICARE: SAMANTHA ROTH

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
1	101YM0800X	Mental Health Counselor	MH17218	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871147371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ROTH

Provider Business Mailing Address
First Line	:	4101 CORAL TREE CIR APT 211
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4413
Country	:	US
Telephone Number	:	786-472-2324
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 CORAL TREE CIR APT 211
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-4413
Country	:	US
Telephone Number	:	786-472-2324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	08/17/2022

Similar Medicare Providers

1750533550 — LUXOTTICA OF AMERICA INC.
Practice Location Address:

4413 LYONS RD , THE PROMENADE AT LYONS
COCONUT CREEK, FL
33073-4383

Practice Phone: 954-970-0398
Practice Fax:

1285965897 — DR. TRISHA A SAGMILLER
Practice Location Address:

4413 LYONS RD , SUITE 101
COCONUT CREEK, FL
33073-4383

Practice Phone: 954-975-9181
Practice Fax: 954-975-9597

1760762769 — DR. ANISA KRISTOLLARI OPTOMETRY DOCTOR
Practice Location Address:

4413 LYONS RD. PROMENADE EYE CARE , STE 101 NEXT TO LENSCRAFTERS OPTIQUE
COCONUT CREEK, FL
33073

Practice Phone: 954-975-9181
Practice Fax: 954-975-9597

1225457716 — PROMENADE EYE CARE, LLC
Practice Location Address:

4413 LYONS RD , SUITE 101 DOCTORS OF OPTOMETRY NEXT TO LENSCRAFTERS
COCONUT CREEK, FL
33073-4383

Practice Phone: 954-975-9181
Practice Fax: 954-975-9597

1619861101 — DR. CAITLYN ALEXIA LUBO OD
Practice Location Address:

4413 LYONS RD STE 101
COCONUT CREEK, FL
33073-4383

Practice Phone: 954-975-9181
Practice Fax:

1851244578 — NORA FARANSSO
Practice Location Address:

1123 S CALIFORNIA BLVD
WALNUT CREEK, CA
94596-4413

Practice Phone: 925-933-8353
Practice Fax:

Directions to “ SAMANTHA ROTH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.