Healthcare Provider Details

I. General information

NPI: 1134401532
Provider Name (Legal Business Name): SONYA S WORTHY MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E DURHAM ST
PHILADELPHIA PA
19119-1823
US

IV. Provider business mailing address

1 JASPER JOHNS WAY
MARLTON NJ
08053-7218
US

V. Phone/Fax

Practice location:
  • Phone: 856-220-0144
  • Fax:
Mailing address:
  • Phone: 856-220-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: