Healthcare Provider Details

I. General information

NPI: 1003156167
Provider Name (Legal Business Name): SOPHIA L PARKER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

14 SUDBURY DR
YONKERS NY
10710-4231
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 914-788-4293
Mailing address:
  • Phone: 914-396-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR054330-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: