Provider Demographics
NPI:1326313206
Name:ROMANOW, DENISE (PSYD, CADC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:ROMANOW
Suffix:
Gender:F
Credentials:PSYD, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3625
Mailing Address - Country:US
Mailing Address - Phone:773-443-9289
Mailing Address - Fax:
Practice Address - Street 1:4933 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3625
Practice Address - Country:US
Practice Address - Phone:773-443-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25499101YA0400X
IL071.011011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)