Provider Demographics
NPI:1730504390
Name:VARA, JAIME VICTOR (BA)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:VICTOR
Last Name:VARA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 COMMONWEALTH AVE
Mailing Address - Street 2:APT 206
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5962
Mailing Address - Country:US
Mailing Address - Phone:847-732-2776
Mailing Address - Fax:
Practice Address - Street 1:112 MARKET ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1125
Practice Address - Country:US
Practice Address - Phone:781-592-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor