Provider Demographics
NPI:1952023327
Name:ROTH, ARIENNE
Entity Type:Individual
Prefix:
First Name:ARIENNE
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41530 BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2049
Mailing Address - Country:US
Mailing Address - Phone:540-683-1817
Mailing Address - Fax:
Practice Address - Street 1:26845 POINT LOOKOUT RD UNIT 1
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-4935
Practice Address - Country:US
Practice Address - Phone:240-309-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health