Individual
BENNETT E ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
161 WEST 15 ST, NEW YORK, NY 10011-6720
(212) 255-0287
Mailing address
161 WEST 15 ST, NEW YORK, NY 10011-6720
(212) 255-0287
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
D04515
NY
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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