Healthcare Provider Details

I. General information

NPI: 1992050108
Provider Name (Legal Business Name): LETICIA ROMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-5308
  • Fax:
Mailing address:
  • Phone: 626-214-5308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW76930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: