Healthcare Provider Details

I. General information

NPI: 1780453548
Provider Name (Legal Business Name): SOVA KATE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOVA KATE PIVEN-KEHRLE

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7108 S KANNER HWY
STUART FL
34997-7462
US

IV. Provider business mailing address

427 ORANGE ST APT 3R
SPRINGFIELD MA
01108-1939
US

V. Phone/Fax

Practice location:
  • Phone: 855-382-6727
  • Fax:
Mailing address:
  • Phone: 914-653-4302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: