Provider Demographics
NPI:1427149913
Name:ROME, ELLEN M (LICSW)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:ROME
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BOW RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2513
Mailing Address - Country:US
Mailing Address - Phone:617-969-7247
Mailing Address - Fax:
Practice Address - Street 1:1093 BEACON ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5695
Practice Address - Country:US
Practice Address - Phone:617-969-7247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10257481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21330Medicare ID - Type Unspecified