Provider Demographics
NPI:1114614336
Name:ROSE-LYN, SOPHIA CAMILLE (THERAPIST, MA,)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:CAMILLE
Last Name:ROSE-LYN
Suffix:
Gender:F
Credentials:THERAPIST, MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 MARINERS WAY APT A
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-6996
Mailing Address - Country:US
Mailing Address - Phone:954-708-8328
Mailing Address - Fax:
Practice Address - Street 1:4850 MARINERS WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-6987
Practice Address - Country:US
Practice Address - Phone:954-708-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health