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General NPI Number Information
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NPI Number | 1225451487
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Entity Type | Individual
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Provider Name | SUSAN M ROY LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 1400 N US HIGHWAY 441 STE 553
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City | THE VILLAGES
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State | FL
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Zip | 32159-8987
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Country | US
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Telephone | 352-706-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 14143 HOLLY HAMMOCK LN
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6863
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Country | US
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Telephone | 631-848-2235
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076751
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15047
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License Number State | FL
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