Healthcare Provider Details

I. General information

NPI: 1245447010
Provider Name (Legal Business Name): SONYA VASSOS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 AVENUE OF THE AMERICAS SUITE 705
NEW YORK NY
10011-8409
US

IV. Provider business mailing address

2 5TH AVE PH N
NEW YORK NY
10011-8842
US

V. Phone/Fax

Practice location:
  • Phone: 212-995-9592
  • Fax: 212-995-9592
Mailing address:
  • Phone: 212-995-9592
  • Fax: 212-995-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002437
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number098-0000197
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: