Provider Demographics
NPI:1164155628
Name:ROMO, YESENIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YESENIA
Middle Name:
Last Name:ROMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 FERDINAND AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1804
Mailing Address - Country:US
Mailing Address - Phone:708-655-1653
Mailing Address - Fax:
Practice Address - Street 1:510 FERDINAND AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1804
Practice Address - Country:US
Practice Address - Phone:708-655-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0206881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical