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Individual

ELIZANNITE MARIE DAVILA ROMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LADCII

Contact information

Practice address
1380 MAIN ST STE 415, SPRINGFIELD, MA 01103-1440
(413) 459-8655
(413) 455-2708
Mailing address
1380 MAIN ST STE 415, SPRINGFIELD, MA 01103-1440
(413) 459-8655
(413) 455-2708

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20661
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
S87753442
DRIVERS
MA
Enumeration date
09/09/2021
Last updated
09/09/2021
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