Provider Demographics
NPI:1235566282
Name:ROMAN, AWILDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AWILDA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0429
Mailing Address - Country:US
Mailing Address - Phone:787-637-1869
Mailing Address - Fax:
Practice Address - Street 1:CALLE 2 PARCELA 168
Practice Address - Street 2:BO. NAVARRO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-0429
Practice Address - Country:US
Practice Address - Phone:787-637-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-07
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4194103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling