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NPI Code Detail

MEDICARE: SOFIA HASSID LCSW

MEDICARE: SOFIA HASSID LCSW
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
11041C0700XClinical Social Worker76388CA
21041C0700XClinical Social Worker16812AZ

General Provider Information

NPI Number : 1770082851
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOFIA HASSID LCSW
Provider Business Mailing Address
First Line : 2401 E ELM ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-4808
Country : US
Telephone Number : 310-279-3590
Fax Number :
Provider Business Practice Location Address
First Line : 3420 E SHEA BLVD STE 188
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-3354
Country : US
Telephone Number : 424-465-3058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2018
Last Update Date : 06/11/2019

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