Provider Demographics
NPI:1447762729
Name:LACROIX, ROY (BCBA)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:LACROIX
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 UNIVERSITY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6509
Mailing Address - Country:US
Mailing Address - Phone:916-448-2050
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY AVE STE 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6509
Practice Address - Country:US
Practice Address - Phone:916-448-2050
Practice Address - Fax:916-448-2050
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-27689103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst