Provider Demographics
NPI:1861240095
Name:ROMERO, TERESA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:ROMERO
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 1:93740 SHUTTERS LANDING LN SPC 20
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-7773
Mailing Address - Country:US
Mailing Address - Phone:541-294-7778
Mailing Address - Fax:
Practice Address - Street 1:93740 SHUTTERS LANDING LN SPC 20
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-7773
Practice Address - Country:US
Practice Address - Phone:541-294-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL113101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical