Healthcare Provider Details

I. General information

NPI: 1255497087
Provider Name (Legal Business Name): XAVIERA ELSIE ROMERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR
ARVERNE NY
11692-1409
US

IV. Provider business mailing address

319 BEACH 98TH ST APT. 9L
ROCKAWAY PARK NY
11694-2852
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax:
Mailing address:
  • Phone: 718-318-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number73072886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: