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NPI Code Detail

MEDICARE: NINOTCHKA ROMAN HERNANDEZ PSYD

MEDICARE: NINOTCHKA ROMAN HERNANDEZ PSYD
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
1103TC0700XClinical PsychologistLP-03375-TKS
2103TC0700XClinical Psychologist295538KY

General Provider Information

NPI Number : 1922825389
Entity Type Code : Individual
Provider Name (Legal Business Name) : NINOTCHKA ROMAN HERNANDEZ PSYD
Provider Business Mailing Address
First Line : 1250 N 113TH ST STE 200
Second Line :
City : WAUWATOSA
State : WI
Zip : 53226-3209
Country : US
Telephone Number : 262-432-6600
Fax Number :
Provider Business Practice Location Address
First Line : 8007 LYNDON CENTRE WAY STE 101
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-3608
Country : US
Telephone Number : 502-690-8024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2024
Last Update Date : 06/26/2026

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