Provider Demographics
NPI:1548051949
Name:ROTH, DARBY (LSW)
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE STE 1925
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5422
Mailing Address - Country:US
Mailing Address - Phone:267-372-0866
Mailing Address - Fax:
Practice Address - Street 1:1021 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3874
Practice Address - Country:US
Practice Address - Phone:815-387-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
IL150113691104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker