Provider Demographics
NPI:1336683416
Name:ROTH, SHARI (LSW)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BRADFORD PL
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2507
Mailing Address - Country:US
Mailing Address - Phone:973-271-8273
Mailing Address - Fax:
Practice Address - Street 1:86 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1748
Practice Address - Country:US
Practice Address - Phone:973-324-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker