Provider Demographics
NPI:1174704688
Name:ROYAL, BARBARA (LADC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:ROYAL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0958
Mailing Address - Country:US
Mailing Address - Phone:207-667-3210
Mailing Address - Fax:207-667-3133
Practice Address - Street 1:8 OLD MILL ROAD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-0958
Practice Address - Country:US
Practice Address - Phone:207-667-3210
Practice Address - Fax:207-667-3133
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ME164770000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
164770000OtherMAINE BMS