Provider Demographics
NPI:1659748051
Name:ROMAN, CAROL (LCSW, CACIII)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LCSW, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 DELAWARE ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2701
Mailing Address - Country:US
Mailing Address - Phone:303-623-4623
Mailing Address - Fax:
Practice Address - Street 1:1337 DELAWARE ST
Practice Address - Street 2:STE. 201
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-2701
Practice Address - Country:US
Practice Address - Phone:303-623-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker