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General NPI Number Information
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NPI Number | 1336805423
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Entity Type | Individual
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Provider Name | JESSICA DANIELA ROYAL
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Gender | Female
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 22 DEPOT ST STE 19
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City | POTSDAM
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State | NY
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Zip | 13676-1140
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Country | US
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Telephone | 315-325-3890
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Fax | 207-823-3715
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Provider Business Mailing Address
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Address Line | 82 REGAN RD
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City | POTSDAM
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State | NY
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Zip | 13676-3208
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Country | US
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Telephone | 920-627-2140
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 115698
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License Number State | NY
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