Healthcare Provider Details

I. General information

NPI: 1245307768
Provider Name (Legal Business Name): JANIS DANIEL ROMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE FL 3
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

2600 REDONDO AVE FL 3
LONG BEACH CA
90806-2325
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-2900
  • Fax:
Mailing address:
  • Phone: 310-918-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS11870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: