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NPI Code Detail

MEDICARE: NICOLE AMANDA ROMAN MSW

MEDICARE: NICOLE AMANDA ROMAN MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social Worker099280NY
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1003499948
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE AMANDA ROMAN MSW
Provider Business Mailing Address
First Line : 169 W 133RD ST
Second Line :
City : NEW YORK
State : NY
Zip : 10030-3301
Country : US
Telephone Number : 201-253-7725
Fax Number :
Provider Business Practice Location Address
First Line : 169 W 133RD ST
Second Line :
City : NEW YORK
State : NY
Zip : 10030-3301
Country : US
Telephone Number : 646-762-4950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2021
Last Update Date : 05/11/2026

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