Provider Demographics
NPI:1811903859
Name:ROTH, BETH L (PHD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:L
Last Name:ROTH
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Mailing Address - Street 1:1400 CARLISLE BLVD NE
Mailing Address - Street 2:STE. A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5658
Mailing Address - Country:US
Mailing Address - Phone:505-255-5835
Mailing Address - Fax:505-841-6758
Practice Address - Street 1:1400 CARLISLE BLVD NE
Practice Address - Street 2:STE. A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5658
Practice Address - Country:US
Practice Address - Phone:505-255-5835
Practice Address - Fax:505-841-6758
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical