Provider Demographics
NPI:1679333496
Name:ROMAN, YANICE AIME
Entity type:Individual
Prefix:MRS
First Name:YANICE
Middle Name:AIME
Last Name:ROMAN
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 1:47 AVE SEVERIANO CUEVAS STE 7
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5759
Mailing Address - Country:US
Mailing Address - Phone:787-882-3682
Mailing Address - Fax:
Practice Address - Street 1:47 AVE SEVERIANO CUEVAS STE 7
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5759
Practice Address - Country:US
Practice Address - Phone:787-882-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4741103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist