Provider Demographics
NPI:1639479603
Name:ROMEO, DONICA J (PHD)
Entity Type:Individual
Prefix:
First Name:DONICA
Middle Name:J
Last Name:ROMEO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 EDISON PL STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-5520
Mailing Address - Country:US
Mailing Address - Phone:760-300-3664
Mailing Address - Fax:
Practice Address - Street 1:5838 EDISON PL STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-5520
Practice Address - Country:US
Practice Address - Phone:760-300-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28006103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical