Provider Demographics
NPI:1679593040
Name:ROBERT E ROTH PSYD
Entity Type:Organization
Organization Name:ROBERT E ROTH PSYD
Other - Org Name:ROTH NEUROPSYCHOLOGY & BEHAVIORAL HEALTH ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:423-952-0500
Mailing Address - Street 1:2333 KNOB CREEK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2007
Mailing Address - Country:US
Mailing Address - Phone:423-952-0500
Mailing Address - Fax:423-950-0005
Practice Address - Street 1:2333 KNOB CREEK RD
Practice Address - Street 2:SUITE 11
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2007
Practice Address - Country:US
Practice Address - Phone:423-952-0500
Practice Address - Fax:423-950-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty