1831266808 NPI number — MARILYN J ROMING MSW, LICSW

Table of content: MARILYN J ROMING MSW, LICSW (NPI 1831266808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831266808 NPI number — MARILYN J ROMING MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMING
Provider First Name:
MARILYN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831266808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5125 BRANDYWINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-6239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-841-6705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 CLIFFORD ST
Provider Second Line Business Practice Location Address:
APT A5
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-841-6705
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  110574 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203602 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 320781943 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 720442000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000027102 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P08405 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007337538 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1852965 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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