Provider Demographics
NPI:1659115004
Name:ROMAN, LUCY L (CASAC ADVANCED)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:L
Last Name:ROMAN
Suffix:
Gender:F
Credentials:CASAC ADVANCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S ROUTE 9W STE 209
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1053
Mailing Address - Country:US
Mailing Address - Phone:845-947-3810
Mailing Address - Fax:845-947-3815
Practice Address - Street 1:45 S ROUTE 9W STE 209
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1053
Practice Address - Country:US
Practice Address - Phone:845-947-3810
Practice Address - Fax:845-947-3815
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18386101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)