Healthcare Provider Details

I. General information

NPI: 1164075172
Provider Name (Legal Business Name): MOISES ROMAN-POMALES MS LMHC QMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD STE 300
WARWICK RI
02886-4416
US

IV. Provider business mailing address

247 5TH ST
FALL RIVER MA
02721-2809
US

V. Phone/Fax

Practice location:
  • Phone: 401-467-0333
  • Fax: 401-467-3917
Mailing address:
  • Phone: 386-215-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01831
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: