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General NPI Number Information
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NPI Number | 1043854193
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Entity Type | Individual
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Provider Name | PAGE SOPHIA MCINTYRE
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Gender | Female
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 935 S LAKE BLVD STE 2
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City | MAHOPAC
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State | NY
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Zip | 10541-3222
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Country | US
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Telephone | 845-628-9284
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Fax |
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Provider Business Mailing Address
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Address Line | 253 POWERS STREET, APT 3RR
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City | BROOKLYN
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State | NY
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Zip | 11211-0051
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Country | US
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Telephone | 845-519-0997
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P103310
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 103310-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 104760-01
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 011775
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License Number State | NY
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