Healthcare Provider Details

I. General information

NPI: 1033038179
Provider Name (Legal Business Name): NADIYA Y ROACHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PILLING ST
BROOKLYN NY
11207-1610
US

IV. Provider business mailing address

1057 ATLANTIC AVE APT 419
BROOKLYN NY
11238-7756
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-1000
  • Fax:
Mailing address:
  • Phone: 716-906-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: