Provider Demographics
NPI:1336910108
Name:ROMAN, JESSICA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:FIBELKORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PSC 473 BOX 1
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96349-0001
Mailing Address - Country:US
Mailing Address - Phone:046-816-7878
Mailing Address - Fax:
Practice Address - Street 1:3365 THIRD AVE
Practice Address - Street 2:
Practice Address - City:YOKOSUKA-SHI
Practice Address - State:JAPAN
Practice Address - Zip Code:2380001
Practice Address - Country:JP
Practice Address - Phone:046-816-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-46691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical