Provider Demographics
NPI:1871837625
Name:ROMAN, BRANDON JAMES (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:JAMES
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MAIN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3828
Mailing Address - Country:US
Mailing Address - Phone:834-863-4588
Mailing Address - Fax:
Practice Address - Street 1:52 MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3828
Practice Address - Country:US
Practice Address - Phone:845-863-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health