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General NPI Number Information
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NPI Number | 1952278939
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Entity Type | Individual
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Provider Name | ANGELA SAN ROMAN
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Gender | Female
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 609 ROUTE 109 STE 2
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City | WEST BABYLON
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State | NY
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Zip | 11704-5068
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Country | US
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Telephone | 631-885-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 8 FRAN LN
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City | SELDEN
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State | NY
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Zip | 11784-2614
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Country | US
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Telephone | 631-513-9736
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NY
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