Healthcare Provider Details

I. General information

NPI: 1972234458
Provider Name (Legal Business Name): KATHLEEN J SOMMERFIELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2966 TRUSTEE AVE
SARASOTA FL
34243-2549
US

IV. Provider business mailing address

2966 TRUSTEE AVE
SARASOTA FL
34243-2549
US

V. Phone/Fax

Practice location:
  • Phone: 630-649-3017
  • Fax:
Mailing address:
  • Phone: 630-649-3017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: