Provider Demographics
NPI:1205656717
Name:ROMERO, JESSICA MORGAN (INTERN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORGAN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 EL MALECON RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2726
Mailing Address - Country:US
Mailing Address - Phone:505-803-0762
Mailing Address - Fax:
Practice Address - Street 1:8500 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1273
Practice Address - Country:US
Practice Address - Phone:505-803-0762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional