Healthcare Provider Details

I. General information

NPI: 1437707577
Provider Name (Legal Business Name): HEIDI M SOSA RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 09/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 COOK ST
BRANDON FL
33511-5216
US

IV. Provider business mailing address

1322 E PARK CIR
TAMPA FL
33604-4337
US

V. Phone/Fax

Practice location:
  • Phone: 813-505-1262
  • Fax:
Mailing address:
  • Phone: 813-505-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW12511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: