Provider Demographics
NPI:1649577396
Name:ROACH, ABBEY ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ABBEY
Middle Name:ROSE
Last Name:ROACH
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-582-7484
Mailing Address - Fax:502-582-7646
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:FRAZIER REHAB INSTITUTE-6TH FLOOR PSYCHOLOGY DPT.
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-582-7484
Practice Address - Fax:502-582-7646
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100162660Medicaid
IN201351950 (KOHMG)Medicaid
KYP00939731Medicare PIN
IN201351950 (KOHMG)Medicaid