Amy Lynn Roth | Port Washington, NY • PECOS Search

Amy Lynn Roth

Social Worker

Behavioral Health & Social Service Providers

11 Orchard Farm Rd, Port Washington, NY 11050-3309

PECOS Enrollment

Based on the most recent information from CMS, provider Amy Lynn Roth does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1356790612
Provider Type
Individual
Full Name
Roth, Amy Lynn
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
6/8/2016
Last Updated
6/8/2016

Contact Information

Practice Location

11 Orchard Farm Rd, Port Washington, NY 11050-3309

Unlisted Fax

Mailing Location

11 Orchard Farm Rd, Port Washington, NY 11050-3309

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 084265-1 New York