Provider Demographics
NPI:1215313390
Name:ROMILUS, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:ROMILUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BRIDLE PATH CIR
Mailing Address - Street 2:APT 723
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4451
Mailing Address - Country:US
Mailing Address - Phone:617-820-1241
Mailing Address - Fax:
Practice Address - Street 1:190 LENOX ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3416
Practice Address - Country:US
Practice Address - Phone:617-820-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling