Healthcare Provider Details

I. General information

NPI: 1821596149
Provider Name (Legal Business Name): SOPHIA MONTISSOL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4555
US

IV. Provider business mailing address

993 SOUTH ST
ROSLINDALE MA
02131-2307
US

V. Phone/Fax

Practice location:
  • Phone: 617-223-7183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2305589
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2305589
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: