Provider Demographics
NPI:1710534805
Name:ROTH, NACHUMA (LMSW, CASAC)
Entity Type:Individual
Prefix:
First Name:NACHUMA
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W 23RD ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4101
Mailing Address - Country:US
Mailing Address - Phone:212-582-1566
Mailing Address - Fax:212-582-1272
Practice Address - Street 1:71 W 23RD ST STE 1400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4101
Practice Address - Country:US
Practice Address - Phone:212-582-1566
Practice Address - Fax:212-586-1272
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110110104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker