Individual
COLLEEN ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
5467 UPPER MOUNTAIN RD STE 200, LOCKPORT, NY 14094-1854
(716) 439-7527
Mailing address
5467 UPPER MOUNTAIN RD STE 200, LOCKPORT, NY 14094-1854
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
096959-1
NY
Other
Enumeration date
04/15/2019
Last updated
04/15/2019
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