Healthcare Provider Details

I. General information

NPI: 1720785207
Provider Name (Legal Business Name): JAMES ROEMBKE JR PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COUNCIL ST
FREDERICK MD
21701-5412
US

IV. Provider business mailing address

3 KLINE BLVD
FREDERICK MD
21701-4019
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-8700
  • Fax:
Mailing address:
  • Phone: 301-620-8700
  • Fax: 301-620-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES E. ROEMBKE JR.
Title or Position: SOLE MEMBER
Credential: PSY.D.
Phone: 301-620-8700