Individual
MR. MARK DAVID ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
118 MAPLE ST, BANGOR, ME 04401-4032
(207) 947-3628
Mailing address
118 MAPLE ST, BANGOR, ME 04401-4032
(207) 947-3628
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
198
ME
Other
Enumeration date
10/20/2010
Last updated
10/20/2010
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