Individual
JEFFREY ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD PSYCHOLOGY
Contact information
Practice address
240 N JAMES ST, SUITES 104-106, WILMINGTON, DE 19804-3169
(302) 633-0301
(302) 633-0331
Mailing address
240 N JAMES ST, SUITES 104-106, WILMINGTON, DE 19804-3169
(302) 633-0301
(302) 633-0331
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
B1-0000251
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000342567
—
DE
05
—
G02128T02
—
PA
Enumeration date
04/03/2007
Last updated
07/09/2007
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