Healthcare Provider Details

I. General information

NPI: 1346064664
Provider Name (Legal Business Name): KATHY ROMAN ST CLAIR LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 I AVE
NEW CASTLE IN
47362-2623
US

IV. Provider business mailing address

PO BOX 29
NEW CASTLE IN
47362-0029
US

V. Phone/Fax

Practice location:
  • Phone: 765-529-3370
  • Fax: 765-529-7269
Mailing address:
  • Phone: 765-529-3370
  • Fax: 765-529-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000946A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: