MEDICARE: DR. MARILU ROMERO PHD

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	101YM0800X	Mental Health Counselor	202732	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01	OTHER		NOT ON ANY INSURANCE PANELS

General Provider Information

NPI Number	:	1750038394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILU ROMERO PHD

Provider Business Mailing Address
First Line	:	421 CONNER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-1114
Country	:	US
Telephone Number	:	562-472-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2728 LUDELLE ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-1211
Country	:	US
Telephone Number	:	682-204-8863
Fax Number	:

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

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	03/03/2022

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