Provider Demographics
NPI:1184632200
Name:ROMAN, RICHARD JEFFREY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JEFFREY
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 BUTTS RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-8739
Mailing Address - Country:US
Mailing Address - Phone:315-337-4435
Mailing Address - Fax:315-337-4435
Practice Address - Street 1:203 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5007
Practice Address - Country:US
Practice Address - Phone:315-337-4435
Practice Address - Fax:315-337-4435
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0269821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical