Provider Demographics
NPI:1205185725
Name:HENRY, SOPHIA
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALCOTT PL
Mailing Address - Street 2:APT 21B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 ALCOTT PL
Practice Address - Street 2:APT 21B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4201
Practice Address - Country:US
Practice Address - Phone:718-671-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641530121252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency