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General NPI Number Information
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NPI Number | 1831899285
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Entity Type | Individual
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Provider Name | SHAWN T SORGE
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Gender | Male
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/06/2023
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Provider Practice Location Address
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Address Line | 423 E 23RD ST
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City | NEW YORK
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State | NY
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Zip | 10010-5011
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Country | US
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Telephone | 347-205-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 521 DEKALB AVE APT 2
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City | BROOKLYN
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State | NY
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Zip | 11205-4862
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Country | US
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Telephone | 814-657-1468
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 025594
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License Number State | NY
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