Healthcare Provider Details

I. General information

NPI: 1396327987
Provider Name (Legal Business Name): SOFIA LISA ANGELINI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALEWIFE BROOK PKWY # 1080
CAMBRIDGE MA
02138-1102
US

IV. Provider business mailing address

160 ALEWIFE BROOK PKWY # 1080
CAMBRIDGE MA
02138-1102
US

V. Phone/Fax

Practice location:
  • Phone: 781-417-3323
  • Fax:
Mailing address:
  • Phone: 781-417-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10002391
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: