Provider Demographics
NPI:1750168928
Name:ROMAN, JOSE JAVIER
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HITCHCOCK ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2927
Mailing Address - Country:US
Mailing Address - Phone:413-887-4497
Mailing Address - Fax:
Practice Address - Street 1:260 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1662
Practice Address - Country:US
Practice Address - Phone:413-534-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician