Provider Demographics
NPI:1043740103
Name:ROMANO, REBECCA K (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:K
Last Name:ROMANO
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-0062
Mailing Address - Country:US
Mailing Address - Phone:719-371-2767
Mailing Address - Fax:
Practice Address - Street 1:402 VALLEY RD STE I
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4176
Practice Address - Country:US
Practice Address - Phone:719-371-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4492080P0006X, 101YP2500X
103TM1800X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist