Provider Demographics
NPI:1023577327
Name:ROTH, MARGARET GAYLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GAYLE
Last Name:ROTH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1352
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24402-1352
Mailing Address - Country:US
Mailing Address - Phone:540-447-0031
Mailing Address - Fax:
Practice Address - Street 1:2303 N AUGUSTA ST STE D
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2597
Practice Address - Country:US
Practice Address - Phone:540-447-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001767103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst