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General NPI Number Information
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NPI Number | 1891572830
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Entity Type | Individual
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Provider Name | JOSEPH ROACH III LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 419 WHALLEY AVE STE 300
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City | NEW HAVEN
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State | CT
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Zip | 06511-3019
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Country | US
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Telephone | 203-285-6575
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Fax | 203-285-6561
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Provider Business Mailing Address
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Address Line | 419 WHALLEY AVE STE 300
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City | NEW HAVEN
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State | CT
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Zip | 06511-3019
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Country | US
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Telephone | 203-285-6575
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Fax | 203-285-6561
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6576
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License Number State | CT
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