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General NPI Number Information
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NPI Number | 1134862121
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Entity Type | Individual
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Provider Name | SOPHIA A SALAS SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 32 UNION SQ E STE 1005
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City | NEW YORK
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State | NY
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Zip | 10003-3237
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Country | US
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Telephone | 414-391-9820
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Fax |
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Provider Business Mailing Address
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Address Line | 250 MERCER ST APT A601
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City | NEW YORK
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State | NY
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Zip | 10012-1177
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Country | US
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Telephone | 414-391-9820
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 19674-130
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License Number State | WI
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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 | P137660
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License Number State | NY
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