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General NPI Number Information
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NPI Number | 1942022504
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Entity Type | Individual
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Provider Name | SOPHIA OLIVIA BROWN
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Gender | Female
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 54 JENNINGS ST
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City | WORCESTER
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State | MA
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Zip | 01604-1973
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Country | US
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Telephone | 774-312-5053
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Fax |
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Provider Business Mailing Address
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Address Line | 108 GROVE ST STE 307
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City | WORCESTER
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State | MA
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Zip | 01605-2651
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Country | US
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Telephone |
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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 | LMHC10002244
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License Number State | MA
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