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General NPI Number Information
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NPI Number | 1922339787
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Entity Type | Individual
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Provider Name | FERMINA LIZA ROMAN LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 11327 VILLAGE BROOK DRIVE
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City | RIVERVIEW
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State | FL
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Zip | 33579
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Country | US
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Telephone | 813-278-7644
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 615
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City | LARES
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State | PR
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Zip | 00669-0615
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Country | US
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Telephone | 787-452-7173
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY11562
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License Number State | FL
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