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General NPI Number Information
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NPI Number | 1700961976
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Entity Type | Individual
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Provider Name | GERALD FREDERICK JOSEPH ROY LCSW, RN
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 15012 LEMOYNE BLVD
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City | BILOXI
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State | MS
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Zip | 39532-5205
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Country | US
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Telephone | 601-434-1358
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13
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City | PERKINSTON
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State | MS
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Zip | 39573-0001
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Country | US
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Telephone | 601-434-1358
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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 | C6761
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License Number State | MS
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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 | 2249C
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R894867
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License Number State | MS
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