Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 104100000X | Social Worker |
NPI | 1003499948 |
---|---|
Provider Name | Nicole Amanda Roman |
First Address | New York, NY 10011-2022 |
Second Address | New York, NY 10027-4990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2021 |
Last Update Date | 29/04/2021 |