Provider Demographics
NPI:1578839502
Name:ROMO JARA, SIRIA FERNANDA (MA)
Entity Type:Individual
Prefix:MS
First Name:SIRIA
Middle Name:FERNANDA
Last Name:ROMO JARA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4612
Mailing Address - Country:US
Mailing Address - Phone:617-697-7897
Mailing Address - Fax:
Practice Address - Street 1:500 AMORY ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2775
Practice Address - Country:US
Practice Address - Phone:617-524-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health