Provider Demographics
NPI:1669542973
Name:ROMERO, SAMUEL (LICSW MSW)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GREYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-322-1164
Mailing Address - Fax:
Practice Address - Street 1:599 CANAL ST
Practice Address - Street 2:4TH FL
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-651-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025838104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP08438OtherBLUE CROSS BLUE SHIELD
MA467786OtherTUFTS
MA189537Medicaid
MA189537Medicaid