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General NPI Number Information
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NPI Number | 1538627872
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Entity Type | Individual
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Provider Name | MARC THOMAS ROMANELLO LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 21111 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3241
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Country | US
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Telephone | 212-273-6272
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Fax |
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Provider Business Mailing Address
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Address Line | 83-85 WASHINGTON ST APT 2E
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City | NORWALK
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State | CT
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Zip | 06854-3014
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Country | US
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Telephone | 631-831-6876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 092595-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105777-1
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License Number State | NY
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