Royce Holden Manifold, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7831 Issued in CT

Practice address

711 Savin Ave
West Haven, CT 06516-4335

Phone

(203) 931-1184

Fax

(475) 234-0805

NPI assigned

Oct 30, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shoreline Wellness Behavioral Health Outreach IncGroup PAC ID 1951796119, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shoreline Wellness Behavioral Health Outreach Inc

  • Community/Behavioral Health Agency
  • West Haven, CT
  • NPI 1144723305
  Medicare reassignment Care Compare group NPD
• Shoreline Wellness Center, LLC.

  • Mental Health Counselor
  • West Haven, CT
  • NPI 1609177815
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1427870427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ELM ST APT 314",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164665",
            "telephone_number": "860-382-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 SAVIN AVE",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164335",
            "telephone_number": "203-931-1184",
            "fax_number": "475-234-0805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIFOLD",
        "first_name": "ROYCE",
        "middle_name": "HOLDEN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "7831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haita S. Makanji, PHARM D.
• Katherine Mala, LCSW
• Melissa Claribel Maldonado
• Brian Joseph Malm, M.D.
• Kanita Mangine
• Berit Mann, RN
• Maggie Manning
• Stefan Mansourian, MD
• William Marano, RPH
• Marathon Healthcare of West Haven

• Mental Health Counselor in West Haven, CT
• Providers in West Haven, CT by specialty
• Mental Health Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.