Provider Demographics
NPI:1891182986
Name:ROMERO, DORA CLEMENCIA (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:DORA
Middle Name:CLEMENCIA
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-5013
Mailing Address - Country:US
Mailing Address - Phone:631-353-5537
Mailing Address - Fax:
Practice Address - Street 1:33 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-5013
Practice Address - Country:US
Practice Address - Phone:631-353-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094156-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health