Provider Demographics
NPI:1568635167
Name:ROMANO, MARY ELLEN (LMHC, CASAC, MAC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:ROMANO
Suffix:
Gender:F
Credentials:LMHC, CASAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SYCAMORE AVE STE 39
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1736
Mailing Address - Country:US
Mailing Address - Phone:631-218-0027
Mailing Address - Fax:631-244-3722
Practice Address - Street 1:1650 SYCAMORE AVE STE 39
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1736
Practice Address - Country:US
Practice Address - Phone:631-218-0027
Practice Address - Fax:631-244-3722
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2815101YA0400X
NY001153-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)