Provider Demographics
NPI:1003810607
Name:ROME, HOWARD P JR (PHD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:P
Last Name:ROME
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N WIGET LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2408
Mailing Address - Country:US
Mailing Address - Phone:925-482-8111
Mailing Address - Fax:925-482-1166
Practice Address - Street 1:450 N WIGET LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2408
Practice Address - Country:US
Practice Address - Phone:925-482-8111
Practice Address - Fax:925-482-1166
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10193103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL101930Medicare UPIN