Provider Demographics
NPI:1235901257
Name:ROTH, COLLEEN NOELLE
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:NOELLE
Last Name:ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N PORTER ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3222
Mailing Address - Country:US
Mailing Address - Phone:302-841-8782
Mailing Address - Fax:
Practice Address - Street 1:256 CHAPMAN RD STE 201
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5415
Practice Address - Country:US
Practice Address - Phone:302-292-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker