Provider Demographics
NPI:1285016147
Name:ROMERO, DAVID JOSEPH
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:ROMERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CALLE ENRIQUE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0196
Mailing Address - Country:US
Mailing Address - Phone:505-988-4131
Mailing Address - Fax:
Practice Address - Street 1:74 CALLE ENRIQUE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0196
Practice Address - Country:US
Practice Address - Phone:505-988-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0170861101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor