Healthcare Provider Details

I. General information

NPI: 1427688878
Provider Name (Legal Business Name): SOPHIA CYRIACKS BSW, MSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 LENOX AVE FL 3
NEW YORK NY
10027-4991
US

IV. Provider business mailing address

301 E 104TH ST APT 3
NEW YORK NY
10029-5519
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3000
  • Fax:
Mailing address:
  • Phone: 609-706-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099290
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: