Healthcare Provider Details

I. General information

NPI: 1245889286
Provider Name (Legal Business Name): SOPHIA BRAHA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 CLERMONT AVE
BROOKLYN NY
11238-2253
US

IV. Provider business mailing address

483 CLERMONT AVE
BROOKLYN NY
11238-2253
US

V. Phone/Fax

Practice location:
  • Phone: 718-643-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: