Provider Demographics
NPI:1598783839
Name:ROMERO, JACKIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:R
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 AIRLINE HIGHWAY
Mailing Address - Street 2:SUITE L
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068
Mailing Address - Country:US
Mailing Address - Phone:985-651-7064
Mailing Address - Fax:985-651-7067
Practice Address - Street 1:421 AIRLINE HIGHWAY
Practice Address - Street 2:SUITE L
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-651-7064
Practice Address - Fax:985-651-7067
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical