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General NPI Number Information
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NPI Number | 1043165863
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Entity Type | Organization
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Legal Business Name | SONNY SOUL LLC
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Dates
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Enumeration Date | 02/27/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 14818 TRINITY FALL WAY
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City | BRADENTON
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State | FL
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Zip | 34212-3923
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Country | US
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Telephone | 914-440-3400
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Fax | 845-531-3100
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Provider Business Mailing Address
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Address Line | 14818 TRINITY FALL WAY
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City | BRADENTON
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State | FL
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Zip | 34212-3923
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Country | US
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Telephone | 914-440-3400
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Fax | 845-531-3100
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. CAROLYN CROCE-MIRQUE
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Credential | LCSW
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Telephone | 914-440-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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