Provider Demographics
NPI:1043510514
Name:SOFER, KEREN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEREN
Middle Name:L
Last Name:SOFER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S BROAD ST
Mailing Address - Street 2:STE 905
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4121
Mailing Address - Country:US
Mailing Address - Phone:267-603-2402
Mailing Address - Fax:
Practice Address - Street 1:230 S BROAD ST
Practice Address - Street 2:STE 905
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4121
Practice Address - Country:US
Practice Address - Phone:267-603-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical