Provider Demographics
NPI:1922643659
Name:MACIAS, ROMULO EMILIO SR
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:EMILIO
Last Name:MACIAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 TIM ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-8437
Mailing Address - Country:US
Mailing Address - Phone:917-769-8766
Mailing Address - Fax:
Practice Address - Street 1:231 TIM ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-8437
Practice Address - Country:US
Practice Address - Phone:917-769-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool