Healthcare Provider Details

I. General information

NPI: 1336065192
Provider Name (Legal Business Name): CLARISSA ROMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10391 DOUBLE R BLVD
RENO NV
89521-5991
US

IV. Provider business mailing address

10391 DOUBLE R BLVD
RENO NV
89521-5991
US

V. Phone/Fax

Practice location:
  • Phone: 775-622-4799
  • Fax: 775-525-3120
Mailing address:
  • Phone: 775-622-4799
  • Fax: 775-525-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: