Healthcare Provider Details

I. General information

NPI: 1902988116
Provider Name (Legal Business Name): MARY PICKWOAD ROMERO L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARY PICKWOAD ROMERO

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 DALY ST FL 2
LOS ANGELES CA
90031-3309
US

IV. Provider business mailing address

555 LAURIE LN APT D10
THOUSAND OAKS CA
91360-5593
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-4447
  • Fax: 323-223-8380
Mailing address:
  • Phone: 323-226-4447
  • Fax: 323-223-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23748
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007715
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: