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General NPI Number Information
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NPI Number | 1568840189
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Entity Type | Individual
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Provider Name | SOPHOUT NOP
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Gender | Male
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 110 BOSTON ST
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City | SALEM
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State | MA
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Zip | 01970-1402
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Country | US
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Telephone | 978-744-7905
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Fax |
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Provider Business Mailing Address
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Address Line | 41 HOUGHTON ST
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City | LYNN
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State | MA
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Zip | 01905-2722
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Country | US
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Telephone | 617-671-5450
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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