Healthcare Provider Details

I. General information

NPI: 1164028981
Provider Name (Legal Business Name): KELEYNA ROMOLEROUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JERICHO TPKE STE 103
JERICHO NY
11753-1317
US

IV. Provider business mailing address

57 BAYBERRY LN
LEVITTOWN NY
11756-4000
US

V. Phone/Fax

Practice location:
  • Phone: 516-399-5373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number06-P144577-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: