Provider Demographics
NPI:1982787800
Name:ROMAN, DEBORAH DECKER (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DECKER
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FULTON ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-4800
Mailing Address - Country:US
Mailing Address - Phone:612-672-7422
Mailing Address - Fax:612-676-8992
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-672-7422
Practice Address - Fax:612-676-8992
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1553103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM61-29460OtherMEDICA CHOICE
MN61-29460OtherMEDICA PRIMARY
MN768324OtherARAZ
MNHP28951OtherHEALTH PARTNERS
MN1015100OtherPREFERRED ONE
MN5T337ROOtherBLUE CROSS BLUE SHIELD
MN102833OtherUCARE
MN842353900Medicaid
MN842353900Medicaid