MEDICARE: MS. JACQUELINE ANN ROMAN MSW, LMSW

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	104100000X	Social Worker	6801082212	MI

General Provider Information

NPI Number	:	1801129945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE ANN ROMAN MSW, LMSW

Provider Business Mailing Address
First Line	:	15021 METTETAL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1939
Country	:	US
Telephone Number	:	313-838-8408
Fax Number	:

Provider Business Practice Location Address
First Line	:	15021 METTETAL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48227-1939
Country	:	US
Telephone Number	:	313-838-8408
Fax Number	:

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

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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