Provider Demographics
NPI:1366611998
Name:MARC J ROMANO, PSY.D., INC.
Entity type:Organization
Organization Name:MARC J ROMANO, PSY.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-296-9464
Mailing Address - Street 1:PO BOX 70516
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-0516
Mailing Address - Country:US
Mailing Address - Phone:954-296-9464
Mailing Address - Fax:954-567-1436
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-296-9464
Practice Address - Fax:954-567-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5846103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54402Medicare UPIN