Provider Demographics
NPI:1386020394
Name:ROMEYN, JACALYNN ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:JACALYNN
Middle Name:ANN
Last Name:ROMEYN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 BROADWAY
Mailing Address - Street 2:APT K6
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204-2841
Mailing Address - Country:US
Mailing Address - Phone:518-420-4192
Mailing Address - Fax:
Practice Address - Street 1:587 BROADWAY
Practice Address - Street 2:APT K6
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204-2841
Practice Address - Country:US
Practice Address - Phone:518-420-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health