Healthcare Provider Details

I. General information

NPI: 1770179657
Provider Name (Legal Business Name): SOSSITY NICO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 41ST AVE STE 102
CAPITOLA CA
95010-2527
US

IV. Provider business mailing address

1840 41ST AVE STE 102
CAPITOLA CA
95010-2527
US

V. Phone/Fax

Practice location:
  • Phone: 831-531-6646
  • Fax:
Mailing address:
  • Phone: 831-531-6646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: