Provider Demographics
NPI:1376697755
Name:ROMER, JEFFREY A (DMINPCC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:ROMER
Suffix:
Gender:M
Credentials:DMINPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2533
Mailing Address - Country:US
Mailing Address - Phone:502-458-1028
Mailing Address - Fax:502-899-5991
Practice Address - Street 1:1864 FRANKFORT AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-3146
Practice Address - Country:US
Practice Address - Phone:502-899-5991
Practice Address - Fax:502-899-5991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist