Provider Demographics
NPI:1861011272
Name:ROMAN, CEJEY (LCPC)
Entity Type:Individual
Prefix:
First Name:CEJEY
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 NEW TRIER CT
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1032
Mailing Address - Country:US
Mailing Address - Phone:847-636-0329
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD STE 138S
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1244
Practice Address - Country:US
Practice Address - Phone:847-636-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional