Provider Demographics
NPI:1447874615
Name:ROMERO, AMANDA ROSE (ASW, MSW, EDD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:ASW, MSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-1025
Mailing Address - Country:US
Mailing Address - Phone:310-846-7247
Mailing Address - Fax:
Practice Address - Street 1:14930 VENTURA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3487
Practice Address - Country:US
Practice Address - Phone:818-570-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW878951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical