Healthcare Provider Details

I. General information

NPI: 1336788538
Provider Name (Legal Business Name): ANNA GRACE SOMPOLSKI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MONTAGUE STREET CONDO UNIT K, 8TH FLOOR
BROOKLYN NY
11201
US

IV. Provider business mailing address

195 MONTAGUE STREET CONDO UNIT K, 8TH FLOOR
BROOKLYN NY
11201
US

V. Phone/Fax

Practice location:
  • Phone: 718-488-0100
  • Fax:
Mailing address:
  • Phone: 718-488-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009044
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: