Provider Demographics
NPI:1659012870
Name:ROMANIK, LUCILLE MARIE (MS)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARIE
Last Name:ROMANIK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 E LAFAYETTE ST STE A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-4767
Mailing Address - Country:US
Mailing Address - Phone:336-624-7898
Mailing Address - Fax:
Practice Address - Street 1:1331 E LAFAYETTE ST STE A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4767
Practice Address - Country:US
Practice Address - Phone:336-624-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health