Roman John Kolodchin, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

6301009313 Issued in MI

Practice address

21056 Dean St
Warren, MI 48091-2760

Phone

(586) 477-7472

Fax

(313) 454-8447

NPI assigned

Oct 1, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Generations Wellness Center

  • Clinical Child & Adolescent Psychologist
  • Warren, MI
  • NPI 1841985900
  NPD Authorized official
• Comprehensive Geriatric Services Inc PC

  • Clinical Social Worker
  • Warren, MI
  • NPI 1730128802
  NPD (past) Authorized official
• Safehaus Inc

  • Psychiatric Residential Treatment Facility
  • Warren, MI
  • NPI 1548402126
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1679900047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21056 DEAN ST",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912760",
            "telephone_number": "586-477-7472",
            "fax_number": "313-454-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21056 DEAN ST",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912760",
            "telephone_number": "586-477-7472",
            "fax_number": "313-454-8447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLODCHIN",
        "first_name": "ROMAN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-01",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6301009313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yong Koh
• Robert Brian Kohen, M.D.
• Kohn & Young, PC
• Mark A. Kohn, D.D.S.
• Carolyn M Koleda, M.A., CCC-SLP
• Skye Kolodin
• Desirae Kolongowski
• McKenna Kate Komro, PA-C
• Danielle Marie Kongeal
• Michelle Ann Konieczny, M.D.

• Clinical Child & Adolescent Psychologist in Warren, MI
• Providers in Warren, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.