Healthcare Provider Details

I. General information

NPI: 1881900173
Provider Name (Legal Business Name): IRENE MARIE ROMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W 97TH ST
LOS ANGELES CA
90003-3968
US

IV. Provider business mailing address

439 W 97TH ST
LOS ANGELES CA
90003-3968
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2856
  • Fax: 323-754-1843
Mailing address:
  • Phone: 323-754-2856
  • Fax: 323-754-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: