Individual
AMY LYNN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
11 ORCHARD FARM RD, PORT WASHINGTON, NY 11050-3309
(516) 767-0533
Mailing address
11 ORCHARD FARM RD, PORT WASHINGTON, NY 11050-3309
(516) 767-0533
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
084265-1
NY
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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