Provider Demographics
NPI:1194782086
Name:PENROSE, STEPHEN ROTH
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROTH
Last Name:PENROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DELL CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7413 DIXIE HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2514
Practice Address - Country:US
Practice Address - Phone:859-547-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor