Provider Demographics
NPI:1205128188
Name:SCOTT A. ROTH, PSY.D., LLC
Entity type:Organization
Organization Name:SCOTT A. ROTH, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-217-0973
Mailing Address - Street 1:70 S MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-3140
Mailing Address - Country:US
Mailing Address - Phone:609-217-0973
Mailing Address - Fax:609-395-0886
Practice Address - Street 1:70 S MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3140
Practice Address - Country:US
Practice Address - Phone:609-217-0973
Practice Address - Fax:609-395-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00466700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty