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Individual
MRS. SUSAN S ROTH
Active
Individual
MRS. SUSAN S ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW DCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
VA0904000691
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2454001
BCBS
—
01
—
78400590
UBH
—
Enumeration date
09/13/2005
Last updated
04/30/2014
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