Provider Demographics
NPI:1285340646
Name:ROMAN, BRENDA IVETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:IVETTE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-0911
Mailing Address - Country:US
Mailing Address - Phone:787-900-8923
Mailing Address - Fax:
Practice Address - Street 1:BO. MINILLAS, CARR. 102, KM 38.5
Practice Address - Street 2:OFFICE 2
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-900-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7445103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical