Basic Information
| Provider Information | |||||||||
| NPI: | 1073662573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | DAGOBERTO | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3430 MARBER AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908082620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628330383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1975 LONG BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625999401 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 29425 | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.