Provider Demographics
NPI:1821579624
Name:ROY, SAMANTHA (MS, LABA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:MS, LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PACELLA PARK DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1755
Mailing Address - Country:US
Mailing Address - Phone:781-437-0791
Mailing Address - Fax:
Practice Address - Street 1:60 CONCORD ST STE I
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2179
Practice Address - Country:US
Practice Address - Phone:781-640-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst