Healthcare Provider Details

I. General information

NPI: 1861014839
Provider Name (Legal Business Name): RENEE ANNE ROMINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W BUSINESS 380 STE 100
DECATUR TX
76234-3267
US

IV. Provider business mailing address

PO BOX 2078
DECATUR TX
76234-6156
US

V. Phone/Fax

Practice location:
  • Phone: 940-539-0683
  • Fax: 940-228-0651
Mailing address:
  • Phone: 940-539-8128
  • Fax: 940-228-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number51303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: