Healthcare Provider Details

I. General information

NPI: 1033246665
Provider Name (Legal Business Name): MARK JOSEPH ROMANCITO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZUNI PUBLIC SCHOOL DISTRICT 12 TWIN BUTTES DRIVE
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 121
ZUNI NM
87327-0121
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5511
  • Fax: 505-782-5870
Mailing address:
  • Phone: 505-782-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number08786852
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: