Provider Demographics
NPI:1497587521
Name:ROMAN, SETH ELLIOT (LMSW)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ELLIOT
Last Name:ROMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 E MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3512
Mailing Address - Country:US
Mailing Address - Phone:631-629-2250
Mailing Address - Fax:
Practice Address - Street 1:258 E MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3512
Practice Address - Country:US
Practice Address - Phone:631-629-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker