Provider Demographics
NPI:1770680944
Name:ROME, ROBERT JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:ROME
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18122 MIRANDA ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1712
Mailing Address - Country:US
Mailing Address - Phone:818-343-1723
Mailing Address - Fax:818-758-0193
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:BLDG 3, SUITE 250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:818-344-4525
Practice Address - Fax:818-344-4584
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPX0085900Medicaid
CAPSY8590OtherLICENSE
CACP8590Medicare ID - Type Unspecified