Provider Demographics
NPI:1083731863
Name:ROYALL, WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ROYALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 MEMORIAL HWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4501
Mailing Address - Country:US
Mailing Address - Phone:813-433-1987
Mailing Address - Fax:
Practice Address - Street 1:6601 MEMORIAL HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4501
Practice Address - Country:US
Practice Address - Phone:813-433-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW51561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1013902956OtherNPI GROUP NUMBER
FL088345003Medicaid