Provider Demographics
NPI:1598141905
Name:ROMERO, MARICELA (CASAC LEVEL 2)
Entity Type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:CASAC LEVEL 2
Other - Prefix:
Other - First Name:MARICELA
Other - Middle Name:
Other - Last Name:CABRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, CASAC LEVEL 2
Mailing Address - Street 1:154 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-4607
Mailing Address - Country:US
Mailing Address - Phone:347-608-6830
Mailing Address - Fax:718-262-8228
Practice Address - Street 1:16318 JAMAICA AVE STE 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4901
Practice Address - Country:US
Practice Address - Phone:718-297-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30246101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor