Provider Demographics
NPI:1003499948
Name:ROMAN, NICOLE AMANDA (MSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMANDA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 ACADEMY ST APT 203
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4323
Mailing Address - Country:US
Mailing Address - Phone:201-253-7725
Mailing Address - Fax:
Practice Address - Street 1:825 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6014
Practice Address - Country:US
Practice Address - Phone:646-799-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health