Provider Demographics
NPI:1518392828
Name:ROMERO, REGILDA ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:REGILDA ANNE
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 NW 40TH TER STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5814
Mailing Address - Country:US
Mailing Address - Phone:352-336-2888
Mailing Address - Fax:
Practice Address - Street 1:2121 NW 40TH TER STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5814
Practice Address - Country:US
Practice Address - Phone:352-336-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5640103TC0700X
FLPY9003103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017029900Medicaid