| Doctor Name: | MS. SALLY ROTH |
| NPI Number: | 1174833065 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | R054025-1 |
| Business Practice Address: | 6369 Mill St Suite #212 Rhinebeck, NY - 125721406 |
| Business Phone Number: | 9175664393 |
| Business Fax Number: | |
| Mailing Address: | 521 Turkey Hill Rd, RED HOOK |
| State: | NY |
| Postal Code: | 125712326 |
| Phone Number: | 8457584306 |
| Fax Number: | |
| NPI Enumeration Date: | 10/14/2010 |
| NPI Last Update Date: | 06/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | R054025-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |