MEDICARE: SOPHIA MARIE DEVITO LMSW

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	104100000X	Social Worker	P103553	NY
2	104100000X	Social Worker	109081-01	NY

General Provider Information

NPI Number	:	1669019691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA MARIE DEVITO LMSW

Provider Business Mailing Address
First Line	:	62 HOLLYWOOD AVE APT 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-2707
Country	:	US
Telephone Number	:	518-542-5952
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 HOLLYWOOD AVE APT 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-2707
Country	:	US
Telephone Number	:	518-542-5952
Fax Number	:

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

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	10/27/2020

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