Provider Demographics
NPI:1427870427
Name:MANIFOLD, ROYCE HOLDEN (LPC)
Entity type:Individual
Prefix:
First Name:ROYCE
Middle Name:HOLDEN
Last Name:MANIFOLD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELM ST APT 314
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4665
Mailing Address - Country:US
Mailing Address - Phone:860-382-8320
Mailing Address - Fax:
Practice Address - Street 1:711 SAVIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4335
Practice Address - Country:US
Practice Address - Phone:203-931-1184
Practice Address - Fax:475-234-0805
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health