Healthcare Provider Details

I. General information

NPI: 1053003095
Provider Name (Legal Business Name): MELISSA ROMANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BARBARITA HL
RANDOLPH NJ
07869-4118
US

IV. Provider business mailing address

3 BARBARITA HL
RANDOLPH NJ
07869-4118
US

V. Phone/Fax

Practice location:
  • Phone: 917-748-7174
  • Fax:
Mailing address:
  • Phone: 917-748-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06729700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: