Doctor Name: | DEBORAH ROTH |
NPI Number: | 1366815151 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.ED. |
License Number: | |
Business Practice Address: | 845 Corey Creek Ln Southold, NY - 119714867 |
Business Phone Number: | 8609662503 |
Business Fax Number: | |
Mailing Address: | 845 Corey Creek Ln, SOUTHOLD |
State: | NY |
Postal Code: | 119714867 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/03/2015 |
NPI Last Update Date: | 11/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |