Healthcare Provider Details

I. General information

NPI: 1245973015
Provider Name (Legal Business Name): SOPHIA F. GEBBIA-RICHARDS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 W 3RD ST APT 709
AUSTIN TX
78701-4165
US

IV. Provider business mailing address

421 W 3RD ST APT 709
AUSTIN TX
78701-4165
US

V. Phone/Fax

Practice location:
  • Phone: 203-246-8771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: