Provider Demographics
NPI:1881589562
Name:HEROLD, ROODY JR
Entity type:Individual
Prefix:
First Name:ROODY
Middle Name:
Last Name:HEROLD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROO
Other - Middle Name:
Other - Last Name:HEROLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7108 SOUTH KANNER HWY, STUART, FL 34997-7462
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:774-259-3250
Mailing Address - Fax:774-259-3250
Practice Address - Street 1:11 CALBERT RD
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4642
Practice Address - Country:US
Practice Address - Phone:774-259-3250
Practice Address - Fax:774-259-3250
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst