Healthcare Provider Details

I. General information

NPI: 1861156374
Provider Name (Legal Business Name): CYNTHIA J ROMAN-CHOUINARD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ALBANY TPKE # 1023
WEST SIMSBURY CT
06092-2903
US

IV. Provider business mailing address

15 ALBANY TPKE # 1023
WEST SIMSBURY CT
06092-2903
US

V. Phone/Fax

Practice location:
  • Phone: 860-801-0421
  • Fax: 860-431-7369
Mailing address:
  • Phone: 860-801-0421
  • Fax: 860-431-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10192
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95040292
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10192
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: