Provider Demographics
NPI:1013403153
Name:ROACH, ALLYSON (MSW)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BOWMANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14026-1044
Mailing Address - Country:US
Mailing Address - Phone:716-681-5077
Mailing Address - Fax:
Practice Address - Street 1:5360 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BOWMANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14026-1044
Practice Address - Country:US
Practice Address - Phone:716-681-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health