Healthcare Provider Details

I. General information

NPI: 1609886654
Provider Name (Legal Business Name): JAROSLAW RICHARD ROMANIUK PH.D., LISW, LICDC,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29166 EUCLID AVE
WICKLIFFE OH
44092-2473
US

IV. Provider business mailing address

29166 EUCLID AVE
WICKLIFFE OH
44092-2473
US

V. Phone/Fax

Practice location:
  • Phone: 216-285-9969
  • Fax: 888-585-4189
Mailing address:
  • Phone: 216-285-9969
  • Fax: 888-585-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0009524
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: