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General NPI Number Information
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NPI Number | 1073249116
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Entity Type | Individual
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Provider Name | SOFIA SIENA VAN SICKLE
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Gender | Female
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 22505 WOODROE AVE
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City | HAYWARD
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State | CA
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Zip | 94541-3410
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Country | US
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Telephone | 510-613-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 272 SANCHEZ ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1614
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Country | US
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Telephone | 631-204-7742
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17761
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License Number State | CA
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