Provider Demographics
NPI:1730396409
Name:ROMASCO, MARIALISA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIALISA
Middle Name:
Last Name:ROMASCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HAVERFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2312
Mailing Address - Country:US
Mailing Address - Phone:610-747-0187
Mailing Address - Fax:
Practice Address - Street 1:6012 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1643
Practice Address - Country:US
Practice Address - Phone:215-487-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA735716Medicare ID - Type Unspecified