Basic Information
| Provider Information | |||||||||
| NPI: | 1528368115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROTH | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 236 RIVERWOODS DR | ||||||||
| Address2: | |||||||||
| City: | NEW HOPE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189382246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158621315 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 278 N UNION ST | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LAMBERTVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085301506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158621315 | ||||||||
| FaxNumber: | 9999999999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC00476300 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.