Provider Demographics
NPI:1689231748
Name:ROCHE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ROCHE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:203-667-7060
Mailing Address - Street 1:75 SILVERMINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-2039
Mailing Address - Country:US
Mailing Address - Phone:203-667-7060
Mailing Address - Fax:
Practice Address - Street 1:762 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4719
Practice Address - Country:US
Practice Address - Phone:203-667-7060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty