Healthcare Provider Details

I. General information

NPI: 1013374180
Provider Name (Legal Business Name): ALYSA ROMANO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 MACARTHUR BLVD STE 214
CABIN JOHN MD
20818-1634
US

IV. Provider business mailing address

7945 MACARTHUR BLVD STE 214
CABIN JOHN MD
20818-1634
US

V. Phone/Fax

Practice location:
  • Phone: 786-719-3642
  • Fax: 503-231-8153
Mailing address:
  • Phone: 786-719-3642
  • Fax: 503-231-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010659
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19392
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC013970
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18347
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4070
License Number StateOR
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC13008
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: