Provider Demographics
NPI:1558656397
Name:ROACH, RASHANNA FRANCES
Entity Type:Individual
Prefix:MISS
First Name:RASHANNA
Middle Name:FRANCES
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VIKING TERRACE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126
Mailing Address - Country:US
Mailing Address - Phone:617-291-4377
Mailing Address - Fax:
Practice Address - Street 1:6 VIKING TER
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2552
Practice Address - Country:US
Practice Address - Phone:617-291-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS66226822104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker