Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 3882663 | AZ |
NPI | 1063668952 |
---|---|
Provider Name | Ms. Jessica Romano |
First Address | Glendale, AZ 85301-1893 |
Second Address | Glendale, AZ 85301-1893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 12/08/2008 |