Provider Demographics
NPI:1982219010
Name:MEDDER-ROMEO, GLADYS A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:A
Last Name:MEDDER-ROMEO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:
Other - Last Name:ROMEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:9614 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-2415
Mailing Address - Country:US
Mailing Address - Phone:757-470-3635
Mailing Address - Fax:757-961-4470
Practice Address - Street 1:9614 GROVE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-2415
Practice Address - Country:US
Practice Address - Phone:757-470-3635
Practice Address - Fax:757-961-4470
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07332101104100000X, 171M00000X, 253Z00000X, 251B00000X
171M00000X, 251X00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty