Provider Demographics
NPI:1891572830
Name:ROACH, JOSEPH III (LMSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ROACH
Suffix:III
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WHALLEY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3019
Mailing Address - Country:US
Mailing Address - Phone:203-285-6575
Mailing Address - Fax:203-285-6561
Practice Address - Street 1:419 WHALLEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3019
Practice Address - Country:US
Practice Address - Phone:203-285-6575
Practice Address - Fax:203-285-6561
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6576104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker