Laurie M Roth, MFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MFC25807 Issued in CA

Practice address

159 Kentucky St
Suite 1
Petaluma, CA 94952-2305

Phone

(707) 778-8414

NPI assigned

Sep 27, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474934400000",
    "number": "1295284644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 KENTUCKY ST STE 1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522324",
            "telephone_number": "707-778-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 KENTUCKY ST",
            "address_2": "SUITE 1",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522305",
            "telephone_number": "707-778-8414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "LAURIE",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "MFC25807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARRIAGE AND FAMILY THERAPY",
            "identifier": "MFC25807",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah Beth Rorvig, M.D., M.S.
• Emily Rosa
• Robert Eugene Rose
• Christopher Michael Rosenthal, DDS
• Ahmbria Yazmeen Ross
• Stephanie Rothman, PH.D.
• Kelly Frances Rowell, AMFT
• Cecilia Roy
• Stacy Roy, MS
• Chalene Roybal

• Mental Health Counselor in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.