Provider Demographics
NPI:1851354518
Name:ROYER, RONALD IRA (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:IRA
Last Name:ROYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CANTON ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3524
Mailing Address - Country:US
Mailing Address - Phone:603-668-0445
Mailing Address - Fax:603-625-0335
Practice Address - Street 1:30 CANTON ST
Practice Address - Street 2:SUITE 13
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3524
Practice Address - Country:US
Practice Address - Phone:603-668-0445
Practice Address - Fax:603-625-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH390103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422491Medicaid