Basic Information
Provider Information | |||||||||
NPI: | 1700923299 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROTH-ROEMER | ||||||||
FirstName: | SARI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 222 W THOMAS RD | ||||||||
Address2: | STE 401 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850134423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6024063473 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 222 W THOMAS RD | ||||||||
Address2: | STE 401 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850134423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6024063473 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/31/2007 | ||||||||
LastUpdateDate: | 07/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103TR0400X | PSY-003240 | AZ | Y |   | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | 103G00000X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   | 103T00000X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Psychologist |   | 103TA0400X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TB0200X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TF0200X | 3240 | AZ | N |   | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.