MEDICARE: SONYA LOTT PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PS006143L	PA

General Provider Information

NPI Number	:	1760935894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONYA LOTT PH.D.

Provider Business Mailing Address
First Line	:	7715 CRITTENDEN ST # 330
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-4421
Country	:	US
Telephone Number	:	267-825-0467
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 E SEDGWICK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1329
Country	:	US
Telephone Number	:	267-825-0467
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. SONYA LALISSE LOTT
Credential	:	PH.D.
Telephone Number	:	267-825-0467

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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