1619014974 NPI number — MRS. KATHLEEN MARIE ROMEIRO LCSW

Table of content: MRS. KATHLEEN MARIE ROMEIRO LCSW (NPI 1619014974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619014974 NPI number — MRS. KATHLEEN MARIE ROMEIRO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMEIRO
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURPHY
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619014974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6777 N WILLOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93710-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-930-2057
Provider Business Mailing Address Fax Number:
559-478-2229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6777 N WILLOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-930-2057
Provider Business Practice Location Address Fax Number:
559-478-2229
Provider Enumeration Date:
01/30/2007

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:  LCSW20129 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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