Healthcare Provider Details

I. General information

NPI: 1750125605
Provider Name (Legal Business Name): SINA TIFFANY MOM-PARRA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DUNHAM RD STE 4150
BEVERLY MA
01915-1882
US

IV. Provider business mailing address

87 GRANT ST APT 2
LYNN MA
01902-3538
US

V. Phone/Fax

Practice location:
  • Phone: 508-493-5493
  • Fax:
Mailing address:
  • Phone: 508-493-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: