Provider Demographics
NPI:1518720663
Name:ROTH, AMY L (DSW, LSW, SSW, HSV)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:ROTH
Suffix:
Gender:F
Credentials:DSW, LSW, SSW, HSV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2986 KINGS LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1617
Mailing Address - Country:US
Mailing Address - Phone:717-330-3664
Mailing Address - Fax:
Practice Address - Street 1:1630 MANHEIM PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3064
Practice Address - Country:US
Practice Address - Phone:717-435-9687
Practice Address - Fax:717-490-6117
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1230721041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool