Healthcare Provider Details

I. General information

NPI: 1386343663
Provider Name (Legal Business Name): SOPHIA FISHBANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 YORKTOWN CT
PRINCETON JCT NJ
08550-1511
US

IV. Provider business mailing address

5 YORKTOWN CT
PRINCETON JCT NJ
08550-1511
US

V. Phone/Fax

Practice location:
  • Phone: 609-529-6615
  • Fax:
Mailing address:
  • Phone: 609-529-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05888100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: