Provider Demographics
NPI:1356180384
Name:ROMERO, LIDIA (LSAA)
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 W DIDIER AVE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3160
Mailing Address - Country:US
Mailing Address - Phone:575-835-4357
Mailing Address - Fax:505-514-0732
Practice Address - Street 1:PO BOX 292
Practice Address - Street 2:
Practice Address - City:TOME
Practice Address - State:NM
Practice Address - Zip Code:87060-0292
Practice Address - Country:US
Practice Address - Phone:505-312-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NMCTB-2024-0713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker