Provider Demographics
NPI:1275007130
Name:ROMINE, REVA MAY (MSW)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:MAY
Last Name:ROMINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-1118
Mailing Address - Country:US
Mailing Address - Phone:856-242-0054
Mailing Address - Fax:
Practice Address - Street 1:2275 BRIDGE ST BLDG 5B132
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1300
Practice Address - Country:US
Practice Address - Phone:215-772-0101
Practice Address - Fax:215-772-0303
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst