MEDICARE: MS. GLADYS A MEDDER-ROMEO 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	07332101	NY
2	171M00000X	Case Manager/Care Coordinator
3	171M00000X	Case Manager/Care Coordinator	07332101	NY
4	251X00000X	Supports Brokerage Agency
5	253Z00000X	In Home Supportive Care Agency	07332101	NY
6	253Z00000X	In Home Supportive Care Agency
7	251B00000X	Case Management Agency	07332101	NY

General Provider Information

NPI Number	:	1982219010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLADYS A MEDDER-ROMEO LMSW

Provider Business Mailing Address
First Line	:	9614 GROVE AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-2415
Country	:	US
Telephone Number	:	757-470-3635
Fax Number	:	757-961-4470

Provider Business Practice Location Address
First Line	:	9614 GROVE AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-2415
Country	:	US
Telephone Number	:	757-470-3635
Fax Number	:	757-961-4470

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

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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