Healthcare Provider Details

I. General information

NPI: 1326164732
Provider Name (Legal Business Name): JUDITH MCCULLOUGH ROMERO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH MCCULLOUGH PH.D.

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4515
  • Fax: 401-444-7018
Mailing address:
  • Phone: 401-444-4515
  • Fax: 401-444-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02248
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS02248
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: