Provider Demographics
NPI:1073830592
Name:ROTH, NANCY LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:ROTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2803
Mailing Address - Country:US
Mailing Address - Phone:215-694-7172
Mailing Address - Fax:
Practice Address - Street 1:1407 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2803
Practice Address - Country:US
Practice Address - Phone:215-694-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional