Provider Demographics
NPI:1093895088
Name:ROTH, FLO B (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FLO
Middle Name:B
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W FONTAINE WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-4355
Mailing Address - Country:US
Mailing Address - Phone:732-308-5505
Mailing Address - Fax:732-292-1888
Practice Address - Street 1:3 W FONTAINE WAY
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-4355
Practice Address - Country:US
Practice Address - Phone:732-496-8030
Practice Address - Fax:732-292-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC040191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ320764OtherMAGELLAN PROVIDER
NJ104295OtherMHN PROVIDER
NJ93662225OtherUBH PROVIDER
NJ3K0788OtherHEALTH NET PROVIDER
NJ5175525OtherAETNA PROVIDER
NJ5175525OtherAETNA PROVIDER