Provider Demographics
NPI:1871372466
Name:ROCHE, KATHLEEN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:ROCHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:ROCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:262 STATE ST STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2273
Mailing Address - Country:US
Mailing Address - Phone:203-491-3118
Mailing Address - Fax:
Practice Address - Street 1:42 JARVIS ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1503
Practice Address - Country:US
Practice Address - Phone:203-806-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0045941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical