Provider Demographics
NPI:1730830480
Name:ROMAN, LINA L (CCHW)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:L
Last Name:ROMAN
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SERVICE AVE BLDG 21
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1014
Mailing Address - Country:US
Mailing Address - Phone:401-430-0371
Mailing Address - Fax:
Practice Address - Street 1:171 SERVICE AVE BLDG 21
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1014
Practice Address - Country:US
Practice Address - Phone:401-430-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty