Provider Demographics
NPI:1235283227
Name:ROY, ILA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILA
Middle Name:S
Last Name:ROY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 S FREDERICK AVENUE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4022
Mailing Address - Country:US
Mailing Address - Phone:301-978-9750
Mailing Address - Fax:301-978-9753
Practice Address - Street 1:16220 S FREDERICK AVENUE
Practice Address - Street 2:SUITE 502
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4022
Practice Address - Country:US
Practice Address - Phone:301-978-9750
Practice Address - Fax:301-978-9753
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD096391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical