Healthcare Provider Details

I. General information

NPI: 1366705758
Provider Name (Legal Business Name): LESLEY YVONNE ROY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 ABBOTT PARK PL WALES HALL, 2ND FLOOR
PROVIDENCE RI
02903-3703
US

IV. Provider business mailing address

3 ELMWOOD CT
MANSFIELD MA
02048-2616
US

V. Phone/Fax

Practice location:
  • Phone: 401-598-1016
  • Fax:
Mailing address:
  • Phone: 617-901-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW02605
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number217291
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: