Provider Demographics
NPI:1164709390
Name:TAYLOR, ROY MARK (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:MARK
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 YORK RD STE C300
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6028
Mailing Address - Country:US
Mailing Address - Phone:410-853-7691
Mailing Address - Fax:443-519-5167
Practice Address - Street 1:1300 YORK RD STE C300
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6028
Practice Address - Country:US
Practice Address - Phone:410-853-7691
Practice Address - Fax:443-519-5167
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11120101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health