Provider Demographics
NPI:1326192048
Name:ROYER, MARIE LISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIE LISE
Middle Name:
Last Name:ROYER
Suffix:
Gender:F
Credentials:PHD
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 1860
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-5860
Mailing Address - Country:US
Mailing Address - Phone:781-224-2820
Mailing Address - Fax:781-224-0074
Practice Address - Street 1:8 CEDAR ST
Practice Address - Street 2:SUITE 58
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7246
Practice Address - Country:US
Practice Address - Phone:781-224-2820
Practice Address - Fax:781-224-0074
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA135081OtherVALUEOPTIONS
MA790711OtherTUFTS
MA001859OtherHPHC-PACIFICARE
MAW10505OtherEMPIRE BC/BS
MA5098732OtherAETNA
MA83501259OtherUBH
MA102931OtherMBH-MAGELLAN
MA1899112Medicaid
MAW10505OtherEMPIRE BC/BS
MA135081OtherVALUEOPTIONS