Healthcare Provider Details

I. General information

NPI: 1497349633
Provider Name (Legal Business Name): SONJA STYBLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 09/30/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OXFORD AVE # 2
BELMONT MA
02478-3661
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 857-212-1144
  • Fax:
Mailing address:
  • Phone: 208-452-8000
  • Fax: 208-452-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8861725
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: