Basic Information
| Provider Information | |||||||||
| NPI: | 1902862881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMERO | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | BEN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5196 N. EAST MEADOWS DR. | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356401227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841153891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019835540 | ||||||||
| FaxNumber: | 8019835542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 134204-3501 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.