Provider Demographics
NPI:1265725055
Name:ROY, BONITA MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:MARIE
Last Name:ROY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9149 ESTATE THOMAS
Mailing Address - Street 2:PARAGON MEDICAL BLDG SUITE 209 A
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-0322
Mailing Address - Country:US
Mailing Address - Phone:340-774-2228
Mailing Address - Fax:340-714-8159
Practice Address - Street 1:9149 ESTATE THOMAS
Practice Address - Street 2:PARAGON MEDICAL BLDG SUITE 209A
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-2228
Practice Address - Fax:340-714-8159
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health