Healthcare Provider Details

I. General information

NPI: 1881103257
Provider Name (Legal Business Name): SOFIA MICHELLE CHERNOFF PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BELMONT AVE STE 503
BALA CYNWYD PA
19004-1608
US

IV. Provider business mailing address

1 BELMONT AVE STE 503
BALA CYNWYD PA
19004-1608
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-3020
  • Fax:
Mailing address:
  • Phone: 610-664-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number10460712-2501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS019684
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10460712-2501
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number10460712-2501
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10460712-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: