Provider Demographics
NPI:1760946891
Name:ROMERO, KELLI MARIE
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MARIE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:MARIE
Other - Last Name:GACIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1477 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6016
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:924 N ALVERNON WAY STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1066
Practice Address - Country:US
Practice Address - Phone:520-207-9348
Practice Address - Fax:520-345-5980
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-176071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical