Healthcare Provider Details

I. General information

NPI: 1174957914
Provider Name (Legal Business Name): INGRID ROMAN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 S DOUGLAS RD STE 215
CORAL GABLES FL
33134-4620
US

IV. Provider business mailing address

7950 W FLAGLER ST STE 105
MIAMI FL
33144-2206
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-5511
  • Fax: 305-768-4600
Mailing address:
  • Phone: 305-661-5511
  • Fax: 305-768-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8783
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPY8783
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: