Provider Demographics
NPI:1821033929
Name:ROACH, LENORE J (LISW,LCSW)
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:J
Last Name:ROACH
Suffix:
Gender:F
Credentials:LISW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DEPEW RD APT 4
Mailing Address - Street 2:
Mailing Address - City:HIGH FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12440-5618
Mailing Address - Country:US
Mailing Address - Phone:845-687-0735
Mailing Address - Fax:
Practice Address - Street 1:300 GRANT AVE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5340
Practice Address - Country:US
Practice Address - Phone:845-336-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO43601-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical