Individual
NICOLE VENTURA ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, RDT
Contact information
Practice address
85 WILLOW ST STE 7, NEW HAVEN, CT 06511-2696
(203) 871-1876
Mailing address
1 BIRCH DR, WALLINGFORD, CT 06492-5210
(201) 669-0057
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
834
—
101YM0800X
Mental Health Counselor
Primary
6384
CT
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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