Healthcare Provider Details

I. General information

NPI: 1326813585
Provider Name (Legal Business Name): SOPHIE MALIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W 38TH ST RM 817
NEW YORK NY
10018-2913
US

IV. Provider business mailing address

307 W 38TH ST RM 817
NEW YORK NY
10018-2913
US

V. Phone/Fax

Practice location:
  • Phone: 212-695-4564
  • Fax:
Mailing address:
  • Phone: 212-695-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: