Provider Demographics
NPI:1770827560
Name:ROTH, ALISON J (MSW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:J
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ELMWOOD PL
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3321
Mailing Address - Country:US
Mailing Address - Phone:917-952-6063
Mailing Address - Fax:
Practice Address - Street 1:36 ELMWOOD PL
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-3321
Practice Address - Country:US
Practice Address - Phone:917-952-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052745001041C0700X
NYRO53248-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical