Provider Demographics
NPI:1376675884
Name:ROTH, JUDY B (LPCC, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:B
Last Name:ROTH
Suffix:
Gender:F
Credentials:LPCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MARKET ST
Mailing Address - Street 2:SUITE 90
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2601
Mailing Address - Country:US
Mailing Address - Phone:330-782-7701
Mailing Address - Fax:330-782-8785
Practice Address - Street 1:5500 MARKET ST
Practice Address - Street 2:SUITE 90
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2601
Practice Address - Country:US
Practice Address - Phone:330-782-7701
Practice Address - Fax:330-782-8785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health