Provider Demographics
NPI:1982120200
Name:ROMERO, EMMANUEL (LMFT)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:MANNY
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:333 CALLE ESCUELA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2108
Mailing Address - Country:US
Mailing Address - Phone:714-494-6154
Mailing Address - Fax:
Practice Address - Street 1:333 CALLE ESCUELA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-2108
Practice Address - Country:US
Practice Address - Phone:714-494-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist