Provider Demographics
NPI:1700031689
Name:ROMERO, ANTONIA (LBSW)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2952
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-528-5539
Practice Address - Street 1:570 W GRIGGS AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2604
Practice Address - Country:US
Practice Address - Phone:575-526-9650
Practice Address - Fax:575-524-6709
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-06627104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker