Provider Demographics
NPI:1285704825
Name:ROMAN, MARY J (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1051 W AREBA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2204
Mailing Address - Country:US
Mailing Address - Phone:717-533-5549
Mailing Address - Fax:717-533-5549
Practice Address - Street 1:56 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2304
Practice Address - Country:US
Practice Address - Phone:717-901-9280
Practice Address - Fax:717-909-1288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS009123L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist