Provider Demographics
NPI:1265043848
Name:NATHAN, SOPHIE ELEANOR (LCSW)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:ELEANOR
Last Name:NATHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W GORGAS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2507
Mailing Address - Country:US
Mailing Address - Phone:443-928-9547
Mailing Address - Fax:
Practice Address - Street 1:110 W GORGAS LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2507
Practice Address - Country:US
Practice Address - Phone:443-928-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0213141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical