Healthcare Provider Details

I. General information

NPI: 1780593210
Provider Name (Legal Business Name): ANTONINA ROMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ALDRICH ST
GOWANDA NY
14070-1095
US

IV. Provider business mailing address

176 W MAIN ST
WESTFIELD NY
14787-1244
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-3328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number132514-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: