Healthcare Provider Details

I. General information

NPI: 1114783636
Provider Name (Legal Business Name): KRISTEN ROMAN PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 UNIVERSITY PL # 11F
NEW YORK NY
10003-4527
US

IV. Provider business mailing address

300 E 71ST ST APT 18C
NEW YORK NY
10021-5238
US

V. Phone/Fax

Practice location:
  • Phone: 656-760-2778
  • Fax:
Mailing address:
  • Phone: 646-760-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN ROMAN
Title or Position: OWNER
Credential: PSY.D.
Phone: 646-760-2778