Provider Demographics
NPI:1457853244
Name:ROMAN, YENAIRA (MED, PC)
Entity Type:Individual
Prefix:MS
First Name:YENAIRA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MED, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 W 3RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1512
Mailing Address - Country:US
Mailing Address - Phone:216-443-8250
Mailing Address - Fax:
Practice Address - Street 1:1276 W 3RD ST STE 210
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-1512
Practice Address - Country:US
Practice Address - Phone:216-443-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1200110101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor