Individual
MRS. LISA MARIE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10 N MAIN ST, BRISTOL, CT 06010-8122
(860) 584-6555
Mailing address
285 TUMBLEBROOK RD, MERIDEN, CT 06450-4759
(203) 217-9971
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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