Individual
LIA ANGELICA ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYA D
Contact information
Practice address
440 NEWKIRK CIR, SAINT CHARLES, MO 63303-6720
(314) 714-5227
Mailing address
440 NEWKIRK CIR, ST CHARLES, MO 63303-6720
(314) 714-5227
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2009030440
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740512854
NPI 2
MO
Enumeration date
05/10/2010
Last updated
01/29/2018
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