Provider Demographics
NPI:1982975033
Name:ROACH, KATHARINE GARDNER (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:GARDNER
Last Name:ROACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1 WALTON PL
Mailing Address - Street 2:STAMFORD COUNSELING CENTER
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-1522
Mailing Address - Country:US
Mailing Address - Phone:203-323-8560
Mailing Address - Fax:203-323-9937
Practice Address - Street 1:1 WALTON PL
Practice Address - Street 2:STAMFORD COUNSELING CENTER
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-1522
Practice Address - Country:US
Practice Address - Phone:203-323-8560
Practice Address - Fax:203-323-9937
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional