Healthcare Provider Details

I. General information

NPI: 1952236572
Provider Name (Legal Business Name): SOPHIA MARIAM MCCUTCHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4664 LARWELL DR
COLUMBUS OH
43220-3621
US

IV. Provider business mailing address

1399 DELASHMUT AVE STE 514
COLUMBUS OH
43212-3146
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-7805
  • Fax: 614-487-7809
Mailing address:
  • Phone: 740-616-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: