Provider Demographics
NPI:1538666953
Name:ROACH, NATALIE CRISTINO (LCSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:CRISTINO
Last Name:ROACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BRITTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3419
Mailing Address - Country:US
Mailing Address - Phone:203-258-8865
Mailing Address - Fax:
Practice Address - Street 1:1558 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3238
Practice Address - Country:US
Practice Address - Phone:203-384-3377
Practice Address - Fax:203-378-8578
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077841041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool