Healthcare Provider Details

I. General information

NPI: 1316352693
Provider Name (Legal Business Name): MERYL BETH ROMER MA, CACIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 BROADWAY ST
BOULDER CO
80304-1824
US

IV. Provider business mailing address

3450 BROADWAY ST
BOULDER CO
80304-1824
US

V. Phone/Fax

Practice location:
  • Phone: 303-441-1287
  • Fax: 303-441-1286
Mailing address:
  • Phone: 303-441-1287
  • Fax: 303-441-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0004145
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: