Provider Demographics
NPI:1891825493
Name:ROMAN, CAMILLE PHYLLIS (MSW)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:PHYLLIS
Last Name:ROMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CAMILLE
Other - Middle Name:PHYLLIS
Other - Last Name:ROMAN CACOPARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:37 CIRCLE ROAD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1301
Mailing Address - Country:US
Mailing Address - Phone:718-225-5070
Mailing Address - Fax:
Practice Address - Street 1:110 EAST 82ND STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:718-225-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRPO146351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical