Provider Demographics
NPI:1194183566
Name:ROMAN, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 GARDELLA AVE
Mailing Address - Street 2:APT 1413
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4055 GARDELLA AVE
Practice Address - Street 2:APT 1413
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1047
Practice Address - Country:US
Practice Address - Phone:775-291-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor