Doctor Name: | KABITA ROY |
NPI Number: | 1154678936 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD RN |
License Number: | LP 5514 |
Business Practice Address: | 15251 Pleasant Valley Rd Center City, MN - 550129640 |
Business Phone Number: | 6512134184 |
Business Fax Number: | |
Mailing Address: | 15251 Pleasant Valley Rd, CENTER CITY |
State: | MN |
Postal Code: | 550129640 |
Phone Number: | 6512134184 |
Fax Number: | |
NPI Enumeration Date: | 08/10/2012 |
NPI Last Update Date: | 08/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TA0400X |
License Number: | LP 5514 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |