Provider Demographics
NPI:1649383126
Name:ROACH, LEILA F (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:F
Last Name:ROACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 S SWEETWATER COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3340
Mailing Address - Country:US
Mailing Address - Phone:407-786-6973
Mailing Address - Fax:
Practice Address - Street 1:631 PALM SPRINGS DR
Practice Address - Street 2:SUITE 114
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7854
Practice Address - Country:US
Practice Address - Phone:407-339-0604
Practice Address - Fax:407-339-2256
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5792101YM0800X
FLMT 2126106H00000X
TN101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional