Provider Demographics
NPI:1457621658
Name:HENNESSEY ROTH, LINDA (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HENNESSEY ROTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HENNESSEY ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT 87270
Mailing Address - Street 1:700 MILL ST STE 14
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1781
Mailing Address - Country:US
Mailing Address - Phone:650-397-1616
Mailing Address - Fax:650-729-0852
Practice Address - Street 1:700 MILL ST STE 14
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1781
Practice Address - Country:US
Practice Address - Phone:650-397-1616
Practice Address - Fax:650-729-0852
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist