Healthcare Provider Details

I. General information

NPI: 1124440730
Provider Name (Legal Business Name): SOFIE HEYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 BEAUMONT RD
BERWYN PA
19312
US

IV. Provider business mailing address

55 DAYLEVIEW RD
BERWYN PA
19312-1204
US

V. Phone/Fax

Practice location:
  • Phone: 609-915-6490
  • Fax:
Mailing address:
  • Phone: 609-915-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1047
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: