Healthcare Provider Details

I. General information

NPI: 1639853906
Provider Name (Legal Business Name): LINDA SORIA LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

462 1ST AVE
NEW YORK NY
10016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-7122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number002766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: