Provider Demographics
NPI:1922339787
Name:ROMAN, FERMINA LIZA (LMHC)
Entity Type:Individual
Prefix:
First Name:FERMINA
Middle Name:LIZA
Last Name:ROMAN
Suffix:
Gender:F
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:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0615
Mailing Address - Country:US
Mailing Address - Phone:787-452-7173
Mailing Address - Fax:
Practice Address - Street 1:11327 VILLAGE BROOK DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579
Practice Address - Country:US
Practice Address - Phone:813-278-7644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11562103T00000X
PR3665103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3665OtherPSYCHOLOGY LICENSE