Provider Demographics
NPI:1306198791
Name:LAIRD, ROY JAMES (PHD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:JAMES
Last Name:LAIRD
Suffix:
Gender:M
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 106TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3686
Mailing Address - Country:US
Mailing Address - Phone:917-288-5924
Mailing Address - Fax:
Practice Address - Street 1:211 W 106TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3686
Practice Address - Country:US
Practice Address - Phone:917-288-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022970R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical