Provider Demographics
NPI:1801025804
Name:JOSEPH, ROODY (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:ROODY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4723
Mailing Address - Country:US
Mailing Address - Phone:203-854-2915
Mailing Address - Fax:
Practice Address - Street 1:17 HIGH ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4723
Practice Address - Country:US
Practice Address - Phone:203-854-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional