Provider Demographics
NPI:1194236760
Name:OFFICES OF MICHAEL A ROMAN PHD
Entity type:Organization
Organization Name:OFFICES OF MICHAEL A ROMAN PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-342-1906
Mailing Address - Street 1:4242 MEDICAL DR STE 7100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5397
Mailing Address - Country:US
Mailing Address - Phone:210-342-1906
Mailing Address - Fax:210-634-2292
Practice Address - Street 1:4242 MEDICAL DR STE 7100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5397
Practice Address - Country:US
Practice Address - Phone:210-342-1906
Practice Address - Fax:210-570-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103G00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TC2200X
TX24435103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty