Provider Demographics
NPI:1568872877
Name:ROMAN, ANDREW (LMHC, RN, LMT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LMHC, RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 RAINBOW CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3605
Mailing Address - Country:US
Mailing Address - Phone:561-310-4587
Mailing Address - Fax:
Practice Address - Street 1:1466 HIPPOCRATES WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-471-5867
Practice Address - Fax:561-471-9464
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health