Provider Demographics
NPI:1720725831
Name:JEAN-JACQUES, ROMIKA
Entity Type:Individual
Prefix:
First Name:ROMIKA
Middle Name:
Last Name:JEAN-JACQUES
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 1:34 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5021
Mailing Address - Country:US
Mailing Address - Phone:857-241-8233
Mailing Address - Fax:
Practice Address - Street 1:34 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5021
Practice Address - Country:US
Practice Address - Phone:857-241-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician