Provider Demographics
NPI:1457676264
Name:ROMERO, MADELINE (PSHYD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PSHYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VIOLETA ST. # 69
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-403-5940
Mailing Address - Fax:787-768-1848
Practice Address - Street 1:AVE. FIDALGO DIAZ, CENTRO COMERCIAL VALLE ARRIBA HEIGHS
Practice Address - Street 2:OFICINA # 207
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-403-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1529101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health