MEDICARE: MRS. TAMI ROMANO CACIII

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1760-01	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ACC.0020846	OTHER	CO	DIVISION OF PROFESSIONS AND OCCUPATIONS

General Provider Information

NPI Number	:	1053854356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMI ROMANO CACIII

Provider Business Mailing Address
First Line	:	5475 MARK DABLING BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3832
Country	:	US
Telephone Number	:	719-426-9450
Fax Number	:

Provider Business Practice Location Address
First Line	:	5475 MARK DABLING BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3832
Country	:	US
Telephone Number	:	719-426-9450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/18/2016

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