Provider Demographics
NPI:1255956371
Name:ROMAN, NOEL (LCSW)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 CARSON LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3812
Mailing Address - Country:US
Mailing Address - Phone:757-232-3685
Mailing Address - Fax:
Practice Address - Street 1:11775 CARSON LAKE DR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3812
Practice Address - Country:US
Practice Address - Phone:757-232-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical