Provider Demographics
NPI:1942633839
Name:ROACHE, CAITLIN REID (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:REID
Last Name:ROACHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHAPMAN ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2040
Mailing Address - Country:US
Mailing Address - Phone:781-828-2418
Mailing Address - Fax:781-298-7920
Practice Address - Street 1:500 CHAPMAN ST UNIT 203
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2040
Practice Address - Country:US
Practice Address - Phone:781-828-2418
Practice Address - Fax:781-298-7920
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical