Provider Demographics
NPI:1356845739
Name:ROMAN, CASSANDRA ELIDE (BACHELOR OF ARTS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ELIDE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:BACHELOR OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1513
Mailing Address - Country:US
Mailing Address - Phone:323-472-7239
Mailing Address - Fax:
Practice Address - Street 1:730 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1513
Practice Address - Country:US
Practice Address - Phone:323-472-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician