Provider Demographics
NPI:1548697022
Name:ROTH, MARCI GAIL (LMSW, MSED)
Entity type:Individual
Prefix:MS
First Name:MARCI
Middle Name:GAIL
Last Name:ROTH
Suffix:
Gender:F
Credentials:LMSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1729
Mailing Address - Country:US
Mailing Address - Phone:914-629-6490
Mailing Address - Fax:
Practice Address - Street 1:9 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1729
Practice Address - Country:US
Practice Address - Phone:914-629-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044228-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker