MEDICARE: SOPHIA FAHA LCSW, CASAC

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	1041C0700X	Clinical Social Worker	099052	NY

General Provider Information

NPI Number	:	1679070486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA FAHA LCSW, CASAC

Provider Business Mailing Address
First Line	:	560 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-3715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 LENOX AVE LOWR LEVEL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4991
Country	:	US
Telephone Number	:	212-663-3000
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	03/21/2025

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