Provider Demographics
NPI:1669210373
Name:ROMERO CHANG, CELIA LISE
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:LISE
Last Name:ROMERO CHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W 24TH ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2192
Mailing Address - Country:US
Mailing Address - Phone:305-728-9167
Mailing Address - Fax:
Practice Address - Street 1:545 W 24TH ST UNIT 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2192
Practice Address - Country:US
Practice Address - Phone:305-728-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician