Healthcare Provider Details

I. General information

NPI: 1679832703
Provider Name (Legal Business Name): SOPHIA MORGENSTERN RANTA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA MORGENSTERN

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LANCASTER ST
PORTLAND ME
04101-2406
US

IV. Provider business mailing address

300 SOUTHBOROUGH DR SUITE 201
SOUTH PORTLAND ME
04106-6914
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1030
  • Fax: 207-874-1044
Mailing address:
  • Phone: 207-661-2018
  • Fax: 207-661-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16035
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: