MEDICARE: DR. SOPHIA JOSEPH PARRILLA PHD, CLINICAL PSYCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	19-041-PSY	VI

General Provider Information

NPI Number	:	1245648146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA JOSEPH PARRILLA PHD, CLINICAL PSYCH

Provider Business Mailing Address
First Line	:	5030 ANCHOR WAY STE 7
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4692
Country	:	US
Telephone Number	:	340-719-7007
Fax Number	:	340-719-6655

Provider Business Practice Location Address
First Line	:	5030 ANCHOR WAY STE 7
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4692
Country	:	US
Telephone Number	:	340-719-7007
Fax Number	:	340-719-6655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	01/12/2020

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