Provider Demographics
NPI:1538241880
Name:ROMO, CASIMIRO (BSW)
Entity type:Individual
Prefix:
First Name:CASIMIRO
Middle Name:
Last Name:ROMO
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HOT SPRINGS BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4175
Mailing Address - Country:US
Mailing Address - Phone:505-425-6786
Mailing Address - Fax:505-425-6787
Practice Address - Street 1:3001 HOT SPRINGS BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4175
Practice Address - Country:US
Practice Address - Phone:505-425-6786
Practice Address - Fax:505-425-6787
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67443Medicaid