Healthcare Provider Details

I. General information

NPI: 1679957070
Provider Name (Legal Business Name): SOPHIA TAYLOR-EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ASYLUM AVE
HARTFORD CT
06105
US

IV. Provider business mailing address

880 ASYLUM AVE
HARTFORD CT
06105-1902
US

V. Phone/Fax

Practice location:
  • Phone: 860-614-1888
  • Fax:
Mailing address:
  • Phone: 860-614-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number001062
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number011054
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: