=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568836930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR ALLEN J ROMEO & ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2015
-----------------------------------------------------
Last Update Date | 11/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1706 DAVIE AVE
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-3589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-872-5990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1706 DAVIE AVE
-----------------------------------------------------
City | STATESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28677-3589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | ALLEN ROMEO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-872-5990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2207
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------