Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178014193 | IL |
NPI | 1003374661 |
---|---|
Provider Name | Miss Julia Rita Romero |
First Address | Chicago, IL 60608-5280 |
Second Address | Riverside, IL 60546-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2019 |
Last Update Date | 03/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000000 | PRIVATE PRACTICE (01) |