=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487391009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRA MENTAL HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2022
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7305 BALTIMORE AVE STE 207
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20740-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-602-7994
-----------------------------------------------------
Fax | 877-763-6239
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7305 BALTIMORE AVE STE 207
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20740-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-763-7737
-----------------------------------------------------
Fax | 877-763-6239
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESS ROMEO
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 205-602-7994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------