Provider Demographics
NPI:1912688367
Name:ROMANIC, REBECCA JEAN (LSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:ROMANIC
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MISSOURI LN
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1976
Mailing Address - Country:US
Mailing Address - Phone:570-259-6346
Mailing Address - Fax:
Practice Address - Street 1:8 W SNYDER ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1504
Practice Address - Country:US
Practice Address - Phone:570-259-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker