Provider Demographics
NPI:1629129135
Name:ROTH, JANE B (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
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 1:4 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2006
Mailing Address - Country:US
Mailing Address - Phone:845-638-6234
Mailing Address - Fax:845-638-6234
Practice Address - Street 1:4 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2006
Practice Address - Country:US
Practice Address - Phone:845-638-6234
Practice Address - Fax:845-638-6234
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033568-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health