Provider Demographics
NPI:1114251709
Name:ROUMO, MONIQUE M
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:M
Last Name:ROUMO
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 1:31 LONGFELLOW ST.
Mailing Address - Street 2:APT. 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02122
Mailing Address - Country:US
Mailing Address - Phone:617-288-2517
Mailing Address - Fax:
Practice Address - Street 1:31 LONGFELLOW ST
Practice Address - Street 2:APT. 3
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1507
Practice Address - Country:US
Practice Address - Phone:617-288-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program