Provider Demographics
NPI:1255160743
Name:ROYAL BLUE BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:ROYAL BLUE BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NORIALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:FUMERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-361-8581
Mailing Address - Street 1:644 NE LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-1231
Mailing Address - Country:US
Mailing Address - Phone:305-879-0565
Mailing Address - Fax:
Practice Address - Street 1:1801 SE HILLMOOR DR STE C-110
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7575
Practice Address - Country:US
Practice Address - Phone:772-361-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health