Provider Demographics
NPI:1548154057
Name:ROMAN, KATELYN (LAC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-3874
Mailing Address - Country:US
Mailing Address - Phone:201-344-5364
Mailing Address - Fax:
Practice Address - Street 1:122 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6368
Practice Address - Country:US
Practice Address - Phone:201-344-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YS0200X, 1041S0200X
NJ37AC00110100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool