Provider Demographics
NPI:1114309044
Name:ROMANO, MICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ROMANO
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 1:909 LAKE SHORE DR
Mailing Address - Street 2:APT. 309
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2860
Mailing Address - Country:US
Mailing Address - Phone:941-735-6650
Mailing Address - Fax:
Practice Address - Street 1:909 LAKE SHORE DR
Practice Address - Street 2:APT. 309
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-2860
Practice Address - Country:US
Practice Address - Phone:941-735-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-27
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker