Provider Demographics
NPI:1306887575
Name:ROTH, WILLIAM M (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:ROTH
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:608 PANCOAST LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1244
Mailing Address - Country:US
Mailing Address - Phone:610-518-6970
Mailing Address - Fax:610-518-6970
Practice Address - Street 1:300 N POTTSTOWN PIKE
Practice Address - Street 2:SUITE 190
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2215
Practice Address - Country:US
Practice Address - Phone:610-518-6970
Practice Address - Fax:610-518-6970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS02499-L103TC2200X
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool