Provider Demographics
NPI:1902500986
Name:ROMO, NELARIE (LEP, NCSP, PPS)
Entity Type:Individual
Prefix:
First Name:NELARIE
Middle Name:
Last Name:ROMO
Suffix:
Gender:F
Credentials:LEP, NCSP, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 COTTAGE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9479
Mailing Address - Country:US
Mailing Address - Phone:559-709-4213
Mailing Address - Fax:
Practice Address - Street 1:1520 YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-1796
Practice Address - Country:US
Practice Address - Phone:209-484-4593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool