Provider Demographics
NPI:1053450239
Name:ROMER-QUIRIN, CONSTANCE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:
Last Name:ROMER-QUIRIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 STRAFFORD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3340
Mailing Address - Country:US
Mailing Address - Phone:215-489-8640
Mailing Address - Fax:215-489-8642
Practice Address - Street 1:175 STRAFFORD AVE., SUITE 1
Practice Address - Street 2:SUITE 17, IRONWOOD BUSINESS CENTER
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1908
Practice Address - Country:US
Practice Address - Phone:215-489-8640
Practice Address - Fax:215-489-8642
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007042L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical