Provider Demographics
NPI:1871804708
Name:BRANDON P. ROMANO PSYD & ASSOCIATES
Entity type:Organization
Organization Name:BRANDON P. ROMANO PSYD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:225-769-2533
Mailing Address - Street 1:PO BOX 41151
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-1151
Mailing Address - Country:US
Mailing Address - Phone:225-769-2533
Mailing Address - Fax:225-769-2441
Practice Address - Street 1:8235 YMCA PLAZA DR
Practice Address - Street 2:STE. 402
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0939
Practice Address - Country:US
Practice Address - Phone:225-769-2533
Practice Address - Fax:225-769-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA977103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA145667Medicaid
LA1396973392OtherINDIVIDUAL NPI