Provider Demographics
NPI:1003670910
Name:ROMANZOV, NIKITA GAYLE
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:GAYLE
Last Name:ROMANZOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3212
Mailing Address - Country:US
Mailing Address - Phone:415-823-8599
Mailing Address - Fax:
Practice Address - Street 1:3238 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3212
Practice Address - Country:US
Practice Address - Phone:415-823-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health