Healthcare Provider Details

I. General information

NPI: 1679485809
Provider Name (Legal Business Name): SOPHIA OGOCHUKWU ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA OGOCHUKWU ROBINSON

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 ASYLUM AVE APT 2E
HARTFORD CT
06105-2412
US

IV. Provider business mailing address

967 ASYLUM AVE APT 2E
HARTFORD CT
06105-2412
US

V. Phone/Fax

Practice location:
  • Phone: 225-501-4003
  • Fax:
Mailing address:
  • Phone: 225-501-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2844017
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: