Provider Demographics
NPI:1518330679
Name:ROMAN, VANESSA L (LMHC, MCAP)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:L
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WINDING CREEK BLVD
Mailing Address - Street 2:#16-204
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4326
Mailing Address - Country:US
Mailing Address - Phone:727-330-4957
Mailing Address - Fax:
Practice Address - Street 1:2400 WINDING CREEK BLVD
Practice Address - Street 2:#16-204
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4326
Practice Address - Country:US
Practice Address - Phone:727-330-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13708101YM0800X
FLMCAP100051101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016124800Medicaid