Provider Demographics
NPI:1245312180
Name:ROMANO, MARC JOSEPH (PSYD, PMHNP, BC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:JOSEPH
Last Name:ROMANO
Suffix:
Gender:
Credentials:PSYD, PMHNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1157
Mailing Address - Country:US
Mailing Address - Phone:954-296-9464
Mailing Address - Fax:954-206-0685
Practice Address - Street 1:2145 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1157
Practice Address - Country:US
Practice Address - Phone:954-296-9464
Practice Address - Fax:954-820-5533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5846103TC0700X
FLARNP9205122363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54402Medicare ID - Type Unspecified