Basic Information
Provider Information
NPI: 1124230354
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROMERO
FirstName: LYNETTE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1124 COLLEGE DR
Address2:  
City: ROCK SPRINGS
State: WY
PostalCode: 829015863
CountryCode: US
TelephoneNumber: 3073526677
FaxNumber: 3073526614
Practice Location
Address1: 1124 COLLEGE DR
Address2:  
City: ROCK SPRINGS
State: WY
PostalCode: 829015863
CountryCode: US
TelephoneNumber: 3073526677
FaxNumber: 3073526614
Other Information
ProviderEnumerationDate: 05/03/2007
LastUpdateDate: 06/02/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X1383CON Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700XLCSW-997WYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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