Provider Demographics
NPI:1801480470
Name:ROMINE, STACY DAWN (LMSW)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:DAWN
Last Name:ROMINE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W 3RD ST APT 1709
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4174
Mailing Address - Country:US
Mailing Address - Phone:512-906-6372
Mailing Address - Fax:
Practice Address - Street 1:2050 DOUBLE CREEK DR STE 150
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2526
Practice Address - Country:US
Practice Address - Phone:512-230-3740
Practice Address - Fax:512-727-1343
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034421041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool