=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700780228
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOFIA NICOLA AUTORE LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2026
-----------------------------------------------------
Last Update Date | 10/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 SPEEDWELL AVE STE 216
-----------------------------------------------------
City | MORRIS PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07950-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-986-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 SPEEDWELL AVE STE 216
-----------------------------------------------------
City | MORRIS PLAINS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07950-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC01005100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------