Basic Information
| Provider Information | |||||||||
| NPI: | 1144629601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROMEO | ||||||||
| FirstName: | KAITLYN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 264 BEACH 141ST ST | ||||||||
| Address2: | |||||||||
| City: | BELLE HARBOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116941230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477073655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7701 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112282413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182321351 | ||||||||
| FaxNumber: | 7188375676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2014 | ||||||||
| LastUpdateDate: | 06/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 001203 | NY | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.