Provider Demographics
NPI:1073604617
Name:ROTH, MARIEL REBECCA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARIEL
Middle Name:REBECCA
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-5316
Mailing Address - Country:US
Mailing Address - Phone:914-588-1374
Mailing Address - Fax:
Practice Address - Street 1:344 E MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3027
Practice Address - Country:US
Practice Address - Phone:914-666-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical