Provider Demographics
NPI:1477163327
Name:SJARIF, KYRA JOHANA
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:JOHANA
Last Name:SJARIF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S MARVINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1913
Mailing Address - Country:US
Mailing Address - Phone:510-371-3073
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2121
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6211
Practice Address - Country:US
Practice Address - Phone:267-603-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012595101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor