Provider Demographics
NPI:1720459712
Name:ROME, SHOSHANNA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:SHOSHANNA
Middle Name:
Last Name:ROME
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:GOLDENS BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10526-0818
Mailing Address - Country:US
Mailing Address - Phone:802-236-4654
Mailing Address - Fax:
Practice Address - Street 1:15 PARKWAY FL 3
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1505
Practice Address - Country:US
Practice Address - Phone:838-900-2876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013341101YM0800X
WI2717-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional