Carly Richelle Roach, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801108306 Issued in MI

Practice address

2135 Buchanan Ave SW
Grand Rapids, MI 49507-2911

Phone

(616) 247-3638

NPI assigned

Feb 20, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cherry Street Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Howard City, MI
  • NPI 1831955251

  Clinical

  NPD
• Cherry Street Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
  • NPI 1558459164

  Social Worker

  NPD
• Counseling Center of West Michigan, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1437610730
  NPD
• Arbor Circle Corporation

  • Clinical Social Worker
  • Grand Rapids, MI
  • NPI 1174601512
  NPD (past)
• Arbor Circle Corporation

  • Community/Behavioral Health Agency
  • Grand Rapids, MI
  • NPI 1740585330
  NPD (past)
• Virtuwell Therapy, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1871356212
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1689066136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2135 BUCHANAN AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495072911",
            "telephone_number": "616-247-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "CARLY",
        "middle_name": "RICHELLE",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-20",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801108306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Atif Rizwan, MD
• RLD LLC
• RLJ Counseling and Psychological
• Eugene Ro, DMD
• Alyssa Roach
• Marie Roach, CNP
• Sonja Andrea Robart
• Hannah Robb, PT, DPT
• Jacob John Robbins
• Robert a. Strobel, DDS, PC

• Clinical Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.