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General NPI Number Information
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NPI Number | 1154733970
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Entity Type | Organization
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Legal Business Name | JACK ROMANO, LMFT, LLC
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 416 HIGHLAND AVE BUILDING B, OFFICE A
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City | CHESHIRE
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State | CT
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Zip | 06410-2527
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Country | US
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Telephone | 203-558-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 462 TORRINGTON RD
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City | LITCHFIELD
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State | CT
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Zip | 06759-2707
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Country | US
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Telephone | 203-558-4141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN CHARLES ROMANO
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Credential | LMFT
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Telephone | 203-558-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001590
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License Number State | CT
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