Provider Demographics
NPI:1407934979
Name:MELLA, ROMULO JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:JOSEPH
Last Name:MELLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 TURKEY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2919
Mailing Address - Country:US
Mailing Address - Phone:904-745-8071
Mailing Address - Fax:904-448-4717
Practice Address - Street 1:5700 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8053
Practice Address - Country:US
Practice Address - Phone:904-448-4700
Practice Address - Fax:904-448-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 57931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical