Provider Demographics
NPI:1750790077
Name:ROY, MARCIA R (LCSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:R
Last Name:ROY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23272 MILL CREEK DR
Mailing Address - Street 2:#150
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1641
Mailing Address - Country:US
Mailing Address - Phone:949-436-6363
Mailing Address - Fax:
Practice Address - Street 1:23272 MILL CREEK DR
Practice Address - Street 2:#150
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1641
Practice Address - Country:US
Practice Address - Phone:949-436-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical