Healthcare Provider Details

I. General information

NPI: 1336074160
Provider Name (Legal Business Name): KELLY A. ROMANO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 ELMWOOD AVE STE 300B
COLUMBIA SC
29201-2150
US

IV. Provider business mailing address

1331 ELMWOOD AVE STE 300B
COLUMBIA SC
29201-2150
US

V. Phone/Fax

Practice location:
  • Phone: 803-250-5109
  • Fax:
Mailing address:
  • Phone: 803-250-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: