Individual
MS. SALLYANN ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
137 BROOKS ST, MEDFORD, MA 02155-2243
(781) 391-0620
Mailing address
137 BROOKS ST, MEDFORD, MA 02155-2243
(781) 391-0620
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
101875
MA
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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