| Doctor Name: | SOPHIE R ROTH |
| NPI Number: | 1003212564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 149017010 |
| Business Practice Address: | 901 N 1st St Suite 225 Springfield, IL - 627023759 |
| Business Phone Number: | 2177884065 |
| Business Fax Number: | 2177884147 |
| Mailing Address: | 710 N 8th St, SPRINGFIELD |
| State: | IL |
| Postal Code: | 627026324 |
| Phone Number: | 2175251064 |
| Fax Number: | 2175251651 |
| NPI Enumeration Date: | 11/11/2014 |
| NPI Last Update Date: | 11/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149017010 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |