Provider Demographics
NPI:1134318348
Name:ROMAINE, AMELIA URBAN (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:URBAN
Last Name:ROMAINE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:URBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATR-BC, LPC
Mailing Address - Street 1:584 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1324
Mailing Address - Country:US
Mailing Address - Phone:856-963-5668
Mailing Address - Fax:
Practice Address - Street 1:311 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1523
Practice Address - Country:US
Practice Address - Phone:856-963-5668
Practice Address - Fax:214-481-4340
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC375900101YM0800X
PAPC005871101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health