MEDICARE: MR. MARC ANTHONY ROMAN LMFT

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	106H00000X	Marriage & Family Therapist	97320	CA

General Provider Information

NPI Number	:	1235421561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC ANTHONY ROMAN LMFT

Provider Business Mailing Address
First Line	:	8581 SANTA MONICA BLVD # 240
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-4120
Country	:	US
Telephone Number	:	415-728-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	7080 HOLLYWOOD BLVD STE 815
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-6935
Country	:	US
Telephone Number	:	888-588-4456
Fax Number	:

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	11/02/2023

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