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NPI Code Detail

MEDICARE: SOPHIA BARRETT PSYD

MEDICARE: SOPHIA BARRETT PSYD
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
1103TC0700XClinical Psychologist34655CA

General Provider Information

NPI Number : 1306606637
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA BARRETT PSYD
Provider Business Mailing Address
First Line : 1619 W PACIFIC COAST HWY APT 147
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-1873
Country : US
Telephone Number : 516-319-4738
Fax Number :
Provider Business Practice Location Address
First Line : 750 E COLORADO BLVD FL 9
Second Line :
City : PASADENA
State : CA
Zip : 91101-5400
Country : US
Telephone Number : 626-354-6440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2024
Last Update Date : 03/21/2024

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