Healthcare Provider Details

I. General information

NPI: 1538826391
Provider Name (Legal Business Name): MARIA JOSE SOTOMAYOR-GIACOMUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

IV. Provider business mailing address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

V. Phone/Fax

Practice location:
  • Phone: 484-440-9416
  • Fax: 484-551-0474
Mailing address:
  • Phone: 484-440-9416
  • Fax: 484-551-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026030
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: