MEDICARE: KARIN MARIE ROMP MFT

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	103T00000X	Psychologist	MFT29238	CA

General Provider Information

NPI Number	:	1114076361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIN MARIE ROMP MFT

Provider Business Mailing Address
First Line	:	4444 RIVERSIDE DR
Second Line	:	SUITE 307
City	:	BURBANK
State	:	CA
Zip	:	91505
Country	:	US
Telephone Number	:	818-843-5206
Fax Number	:	818-541-1615

Provider Business Practice Location Address
First Line	:	4444 RIVERSIDE DR
Second Line	:	SUITE 307
City	:	BURBANK
State	:	CA
Zip	:	91505
Country	:	US
Telephone Number	:	818-843-5206
Fax Number	:	818-541-1615

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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