Provider Demographics
NPI:1194220343
Name:ROMAN, DAHLIA (MSW, LSW, CADC)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MSW, LSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9508
Mailing Address - Country:US
Mailing Address - Phone:815-757-2512
Mailing Address - Fax:
Practice Address - Street 1:2600 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3131
Practice Address - Country:US
Practice Address - Phone:815-787-9000
Practice Address - Fax:815-787-9015
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103076104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker