Provider Demographics
NPI:1235689571
Name:ROY, WILLIAM BENJAMIN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:ROY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 DARNIT RD
Mailing Address - Street 2:
Mailing Address - City:BUCKFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-4519
Mailing Address - Country:US
Mailing Address - Phone:207-602-9059
Mailing Address - Fax:
Practice Address - Street 1:415 RODMAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-376-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-13-14831103K00000X
MEPS1535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst