Provider Demographics
NPI:1609316025
Name:ROMAN, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 AOLOA ST
Mailing Address - Street 2:#A122
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3018
Mailing Address - Country:US
Mailing Address - Phone:808-690-2682
Mailing Address - Fax:
Practice Address - Street 1:350 AOLOA ST
Practice Address - Street 2:#A122
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3018
Practice Address - Country:US
Practice Address - Phone:808-690-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-41891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical