Healthcare Provider Details

I. General information

NPI: 1811597552
Provider Name (Legal Business Name): DEANAHA M ROMERO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 N 30TH AVE
PHOENIX AZ
85017-4607
US

IV. Provider business mailing address

7141 W CARTER RD
LAVEEN AZ
85339-7059
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-6143
  • Fax: 480-781-4566
Mailing address:
  • Phone: 623-322-6143
  • Fax: 480-781-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20874
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: