Provider Demographics
NPI:1538882931
Name:ROMERO, GINA M (LSWAIC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S HORTON ST
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001-5283
Mailing Address - Country:US
Mailing Address - Phone:206-331-6309
Mailing Address - Fax:
Practice Address - Street 1:13126 W SUNSET HWY
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001
Practice Address - Country:US
Practice Address - Phone:509-380-9917
Practice Address - Fax:509-271-0290
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609384781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical