Amy Lynn Roth, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

084265-1 Issued in NY

Practice address

11 Orchard Farm Rd
Port Washington, NY 11050-3309

Phone

(516) 767-0533

NPI assigned

Jun 8, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shine Medical PC

  • Psychiatry Physician
  • New York, NY
  • NPI 1427783950
  NPD (past)

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465344000000",
    "number": "1356790612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ORCHARD FARM RD",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110503309",
            "telephone_number": "516-767-0533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 ORCHARD FARM RD",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110503309",
            "telephone_number": "516-767-0533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "AMY",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "084265-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leahanna Rook, OTR/L
• Marion J Rosenbaum, PH.D.
• John P Rosenboom, PHARMD
• Sandra Rosengarten, LCSW
• Helen Monica Roslow, M.S., L.AC.
• Elissa S Rotolo, MS, CCC-SLP
• Glen Scott Ruben, DDS
• Eileen Rubin, LCSW
• Ariana Marie Rusoff, MHC-LP
• Rxusapbm, Inc.

• Clinical Social Worker in Port Washington, NY
• Providers in Port Washington, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.