Provider Demographics
NPI:1932331774
Name:ROY, REBECCA JO (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:ROY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 VINEYARDS CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-3806
Mailing Address - Country:US
Mailing Address - Phone:765-418-4979
Mailing Address - Fax:
Practice Address - Street 1:701 N ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9744
Practice Address - Country:US
Practice Address - Phone:765-361-9767
Practice Address - Fax:765-361-0374
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006219A1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical