Provider Demographics
NPI:1235421561
Name:ROMAN, MARC ANTHONY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ANTHONY
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8581 SANTA MONICA BLVD # 240
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4120
Mailing Address - Country:US
Mailing Address - Phone:415-728-3902
Mailing Address - Fax:
Practice Address - Street 1:7080 HOLLYWOOD BLVD STE 815
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-6935
Practice Address - Country:US
Practice Address - Phone:888-588-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97320106H00000X, 106H00000X
172V00000X, 172V00000X, 171M00000X
CA58692320800000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No171M00000XOther Service ProvidersCase Manager/Care Coordinator