Healthcare Provider Details

I. General information

NPI: 1720198500
Provider Name (Legal Business Name): LOUIS AIME ROY JR. EDD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 COUNTY ST
NEW BEDFORD MA
02740-5000
US

IV. Provider business mailing address

27 NORTH ST
FAIRHAVEN MA
02719-4235
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-2112
  • Fax: 508-990-0666
Mailing address:
  • Phone: 508-996-2112
  • Fax: 508-990-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3047
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3047
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3047
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3047
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3047
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: