Provider Demographics
NPI:1699799536
Name:ROMAN, YORAM MOSHE (PHD, MFT)
Entity type:Individual
Prefix:
First Name:YORAM
Middle Name:MOSHE
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E OLIVE AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-845-3510
Mailing Address - Fax:818-845-0528
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-845-3510
Practice Address - Fax:818-845-0528
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist