Provider Demographics
NPI:1447484498
Name:ROTH, SCOTT AARON (PSYD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:AARON
Last Name:ROTH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-3140
Mailing Address - Country:US
Mailing Address - Phone:609-217-0973
Mailing Address - Fax:609-395-0886
Practice Address - Street 1:70 S MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3140
Practice Address - Country:US
Practice Address - Phone:609-217-0973
Practice Address - Fax:609-395-0886
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist