Healthcare Provider Details

I. General information

NPI: 1790515005
Provider Name (Legal Business Name): GENEVIEVE ROMELUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8061 NW 47TH CT
LAUDERHILL FL
33351-5627
US

IV. Provider business mailing address

8061 NW 47TH CT
LAUDERHILL FL
33351-5627
US

V. Phone/Fax

Practice location:
  • Phone: 786-218-7807
  • Fax:
Mailing address:
  • Phone: 786-218-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: