Healthcare Provider Details
I. General information
NPI: 1437967726
Provider Name (Legal Business Name): ROYAL REGIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/19/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
202 CLARE AVE
HYDE PARK MA
02136-2204
US
IV. Provider business mailing address
1690 BOSTON RD STE 1047
SPRINGFIELD MA
01129-1153
US
V. Phone/Fax
- Phone: 877-566-3993
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MRS.
MONIQUE
SELDEN-RILEY
Title or Position: FOUNDER & CLINICAL DIRECTOR
Credential: PMHNP-BC, LMHC/LPC
Phone: 877-566-3993