Healthcare Provider Details

I. General information

NPI: 1528695863
Provider Name (Legal Business Name): SONJA L SIMPSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 W AIRDRIE ST APT 3
PHILADELPHIA PA
19140-3707
US

IV. Provider business mailing address

1242 W AIRDRIE ST APT 3
PHILADELPHIA PA
19140-3707
US

V. Phone/Fax

Practice location:
  • Phone: 484-844-9003
  • Fax:
Mailing address:
  • Phone: 484-844-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBH006433
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: