MEDICARE: MARY ELLEN ROTH LPCC-S

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	101YP2500X	Professional Counselor	E.0007784-SUPV	OH

General Provider Information

NPI Number	:	1891082566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN ROTH LPCC-S

Provider Business Mailing Address
First Line	:	695 SOUTH STREET, #6
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024
Country	:	US
Telephone Number	:	440-286-1553
Fax Number	:	440-286-1318

Provider Business Practice Location Address
First Line	:	695 SOUTH STREET, #6
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024
Country	:	US
Telephone Number	:	440-286-1553
Fax Number	:	440-286-1318

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	03/10/2026

Similar Medicare Providers

1982244158 — YESENIA MARLENE PAXTON
Practice Location Address:

12557 RAVENWOOD DR
CHARDON, OH
44024-9009

Practice Phone: 440-285-3568
Practice Fax:

1487500526 — KATELYNN AMBER PICABO SALYAN
Practice Location Address:

531 5TH AVE
CHARDON, OH
44024-1088

Practice Phone: 440-285-2300
Practice Fax:

1447137906 — ZOE ALLISON
Practice Location Address:

12557 RAVENWOOD DR
CHARDON, OH
44024-9009

Practice Phone: 440-285-3568
Practice Fax:

1386591006 — NICHOLE HAYES
Practice Location Address:

12041 RAVENNA RD
CHARDON, OH
44024-7008

Practice Phone: 440-286-7154
Practice Fax:

1457821282 — MICHELLE OLIVIA BENZ LPC
Practice Location Address:

203 MAIN ST
CHARDON, OH
44024-1538

Practice Phone: 440-214-9062
Practice Fax:

1730036096 — MERRIAM DE GRACIA RETTINGER
Practice Location Address:

12550 CLARIDON TROY RD APT 5
CHARDON, OH
44024-7975

Practice Phone: 216-403-6820
Practice Fax:

Directions to “ MARY ELLEN ROTH LPCC-S” 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.