Provider Demographics
NPI:1538415534
Name:ROMANKI, MATTHEW PETER (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PETER
Last Name:ROMANKI
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 STEAM MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:NY
Mailing Address - Zip Code:14869-9606
Mailing Address - Country:US
Mailing Address - Phone:607-333-4650
Mailing Address - Fax:
Practice Address - Street 1:77 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2715
Practice Address - Country:US
Practice Address - Phone:607-333-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075302-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health