Provider Demographics
NPI:1760734230
Name:JENNIFER ROMERO LCSW, CADC, LLC
Entity Type:Organization
Organization Name:JENNIFER ROMERO LCSW, CADC, LLC
Other - Org Name:RESTORED PATHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:208-664-8347
Mailing Address - Street 1:2900 N GOVERNMENT WAY
Mailing Address - Street 2:#136
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-3751
Mailing Address - Country:US
Mailing Address - Phone:208-664-8347
Mailing Address - Fax:208-664-9217
Practice Address - Street 1:109 E HARRISON AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3238
Practice Address - Country:US
Practice Address - Phone:208-664-8347
Practice Address - Fax:208-664-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health