Healthcare Provider Details

I. General information

NPI: 1871804708
Provider Name (Legal Business Name): BRANDON P. ROMANO PSYD & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 YMCA PLAZA DR STE. 402
BATON ROUGE LA
70810-0939
US

IV. Provider business mailing address

PO BOX 41151
BATON ROUGE LA
70835-1151
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2533
  • Fax: 225-769-2441
Mailing address:
  • Phone: 225-769-2533
  • Fax: 225-769-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number977
License Number StateLA

VIII. Authorized Official

Name: BRANDON P ROMANO
Title or Position: MBR
Credential: PSYD
Phone: 225-769-2533