Provider Demographics
NPI:1417290420
Name:LYSENKO, ROMELLE HOLMGREN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROMELLE
Middle Name:HOLMGREN
Last Name:LYSENKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GIFFORD RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2306
Mailing Address - Country:US
Mailing Address - Phone:848-565-7052
Mailing Address - Fax:
Practice Address - Street 1:16 GIFFORD RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2306
Practice Address - Country:US
Practice Address - Phone:848-565-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055167001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical