Provider Demographics
NPI:1700961976
Name:ROY, GERALD FREDERICK JOSEPH (LCSW, RN)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:FREDERICK JOSEPH
Last Name:ROY
Suffix:
Gender:M
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:PERKINSTON
Mailing Address - State:MS
Mailing Address - Zip Code:39573-0001
Mailing Address - Country:US
Mailing Address - Phone:601-434-1358
Mailing Address - Fax:
Practice Address - Street 1:15012 LEMOYNE BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-5205
Practice Address - Country:US
Practice Address - Phone:601-434-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC67611041C0700X
AL2249C1041C0700X
MSR894867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse