Healthcare Provider Details

I. General information

NPI: 1194046011
Provider Name (Legal Business Name): ANASTASIA MARIE SOCIE MA/CAS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 FOREST ST
DOVER DE
19904-3401
US

IV. Provider business mailing address

115 BONNYBROOK RD
MIDDLETOWN DE
19709-1636
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-1500
  • Fax:
Mailing address:
  • Phone: 252-412-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number47744
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: