Organization
VITAL SOURCES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES E. ROEMBKE JR. PSY.D. (MEMBER)
(301) 620-8700
Entity
Organization
Contact information
Practice address
116 RECORD ST, FREDERICK, MD 21701-5418
(301) 620-8700
(301) 620-8710
Mailing address
116 RECORD ST, FREDERICK, MD 21701-5418
(301) 620-8700
(301) 620-8710
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
Other
Enumeration date
04/04/2007
Last updated
07/05/2016
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