Healthcare Provider Details

I. General information

NPI: 1548154057
Provider Name (Legal Business Name): KATELYN ROMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W SYLVANIA AVE
NEPTUNE CITY NJ
07753-6368
US

IV. Provider business mailing address

56 CAMELOT DR
FARMINGDALE NJ
07727-3874
US

V. Phone/Fax

Practice location:
  • Phone: 201-344-5364
  • Fax:
Mailing address:
  • Phone: 201-344-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01269900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: