Provider Demographics
NPI:1023566742
Name:ROMERO, RICHARD (RADTI)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:RADTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 PENNIMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1717
Mailing Address - Country:US
Mailing Address - Phone:415-865-0964
Mailing Address - Fax:415-865-5428
Practice Address - Street 1:4136 PENNIMAN AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1717
Practice Address - Country:US
Practice Address - Phone:415-865-0964
Practice Address - Fax:415-865-5428
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1236600816101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)