Provider Demographics
NPI:1417324880
Name:ROACHE & ASSOCIATES
Entity Type:Organization
Organization Name:ROACHE & ASSOCIATES
Other - Org Name:NICOLA ROACHE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROACHE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-269-0069
Mailing Address - Street 1:18710 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1052
Mailing Address - Country:US
Mailing Address - Phone:708-552-6085
Mailing Address - Fax:
Practice Address - Street 1:1 E WACKER DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1474
Practice Address - Country:US
Practice Address - Phone:847-269-0069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty