Basic Information
| Provider Information | |||||||||
| NPI: | 1982787800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | DECKER | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 FULTON ST SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554554800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126727422 | ||||||||
| FaxNumber: | 6126768992 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 FULTON ST SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554554800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126727422 | ||||||||
| FaxNumber: | 6126768992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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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 | 103T00000X | LP1553 | MN | N | Behavioral Health & Social Service Providers | Psychologist | 103G00000X | LP1553 | MN | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
ID Information
| ID | Type | State | Issuer | Description | 61-29460 | 01 | FM | MEDICA CHOICE | OTHER | 61-29460 | 01 | MN | MEDICA PRIMARY | OTHER | 768324 | 01 | MN | ARAZ | OTHER | HP28951 | 01 | MN | HEALTH PARTNERS | OTHER | 1015100 | 01 | MN | PREFERRED ONE | OTHER | 5T337RO | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 102833 | 01 | MN | UCARE | OTHER | 842353900 | 05 | MN | MEDICAID |