MEDICARE: MS. JUDITH ANN ROMAINE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1326045170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ANN ROMAINE LCSW

Provider Business Mailing Address
First Line	:	15507 MINERVA AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-2722
Country	:	US
Telephone Number	:	708-206-0495
Fax Number	:	708-841-0185

Provider Business Practice Location Address
First Line	:	19150 KEDZIE
Second Line	:	STE 205
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422
Country	:	US
Telephone Number	:	708-206-0495
Fax Number	:	708-411-0185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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