Healthcare Provider Details

I. General information

NPI: 1740829621
Provider Name (Legal Business Name): ROYAL PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2019
Last Update Date: 12/25/2019
Certification Date: 12/25/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W BROAD ST STE 800
LAKE CHARLES LA
70601-4297
US

IV. Provider business mailing address

1385 E 22ND ST
BROOKLYN NY
11210-5110
US

V. Phone/Fax

Practice location:
  • Phone: 929-469-5556
  • Fax:
Mailing address:
  • Phone: 929-469-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIE COHEN
Title or Position: PRESIDENT
Credential:
Phone: 929-469-5556