Provider Demographics
NPI:1902988116
Name:ROMERO, MARY PICKWOAD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:PICKWOAD
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:PICKWOAD
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:555 LAURIE LN APT D10
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5593
Mailing Address - Country:US
Mailing Address - Phone:323-226-4447
Mailing Address - Fax:323-223-8380
Practice Address - Street 1:1925 DALY ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-3309
Practice Address - Country:US
Practice Address - Phone:323-226-4447
Practice Address - Fax:323-223-8380
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS237481041C0700X
WALH00007715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health