Healthcare Provider Details

I. General information

NPI: 1972069052
Provider Name (Legal Business Name): GINA RENE ROMANO BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 PARK PLACE CT
MISHAWAKA IN
46545-3581
US

IV. Provider business mailing address

822 S 35TH ST
SOUTH BEND IN
46615-2408
US

V. Phone/Fax

Practice location:
  • Phone: 574-207-0648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: