Provider Demographics
NPI:1053763219
Name:ROMANO, KATE
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:ROMANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E WYLIE AVE STE 2AND3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-2059
Mailing Address - Country:US
Mailing Address - Phone:724-222-6220
Mailing Address - Fax:
Practice Address - Street 1:50 E WYLIE AVE STE 2AND3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-2059
Practice Address - Country:US
Practice Address - Phone:724-222-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA637041171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030895220001Medicaid