Andrew Roth, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35SI00375000 Issued in NJ

Practice address

55 Park St
Montclair, NJ 07042-3439

Phone

(973) 378-5641

Fax

(973) 762-0045

NPI assigned

Feb 4, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prism Counseling and Consulting

  • Clinical Social Worker
  • Montclair, NJ
  • NPI 1285135012
  NPD
• Park Avenue Medical Associates, P.C.

  • Geriatric Medicine (Family Medicine) Physician
  • White Plains, NY
  • NPI 1730138645
  NPD (past)
• Vericare Behavioral Health of New Jersey, P.a.

  • Clinical Psychologist
  • San Diego, CA
  • NPI 1669408274
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1013055649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 HARRISON CT",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792409",
            "telephone_number": "973-378-5641",
            "fax_number": "973-821-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 PARK ST",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423439",
            "telephone_number": "973-378-5641",
            "fax_number": "973-762-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ANDREW",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-04",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00375000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Rosenblum
• Lauren Rosenblum, D.O.
• Irene Rosenthal, LCSW
• Jody Lee Ross, DMD
• Margaret Ross
• Robert Marc Rothberg, M.D.
• Rebecca G Rothman, LAC
• Paul Rotunda, DMD
• Rowen Diano MD PA
• Roxanne Ruiz-Adams, LLC

• Clinical Psychologist in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.