Healthcare Provider Details

I. General information

NPI: 1740192913
Provider Name (Legal Business Name): JOSE DANIEL ROMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 791
HOLYOKE MA
01041-0791
US

IV. Provider business mailing address

PO BOX 1474
TRUJILLO ALTO PR
00977-1474
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax: 413-538-5169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: