Provider Demographics
NPI:1700199361
Name:ROACH, DIANA MARIE (LPC, CCMHC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:ROACH
Suffix:
Gender:F
Credentials:LPC, CCMHC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:FALZARANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 COBBLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-2321
Mailing Address - Country:US
Mailing Address - Phone:862-266-3217
Mailing Address - Fax:
Practice Address - Street 1:4 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1710
Practice Address - Country:US
Practice Address - Phone:862-266-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00018200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional