Healthcare Provider Details

I. General information

NPI: 1356479182
Provider Name (Legal Business Name): RAMON ROMAN JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 DOE RUN DR.
ST. CLOUD FL
34772
US

IV. Provider business mailing address

3640 DOE RUN DR.
ST. CLOUD FL
34772
US

V. Phone/Fax

Practice location:
  • Phone: 407-433-8557
  • Fax:
Mailing address:
  • Phone: 407-433-8557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: