Provider Demographics
NPI:1215153960
Name:ROMERO, ANTONIO (MA)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:ROMERO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G39 CALLE 6
Mailing Address - Street 2:TINTILLO GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1629
Mailing Address - Country:US
Mailing Address - Phone:787-781-5477
Mailing Address - Fax:787-721-4961
Practice Address - Street 1:403 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3709
Practice Address - Country:US
Practice Address - Phone:787-721-4960
Practice Address - Fax:787-721-4961
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR172101YA0400X
PR796103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist