Provider Demographics
NPI:1346911419
Name:VIDA, SOPHIE NEUHOFF (MA)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:NEUHOFF
Last Name:VIDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 MOSS CREEK PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2863
Mailing Address - Country:US
Mailing Address - Phone:317-473-2150
Mailing Address - Fax:
Practice Address - Street 1:10291 N MERIDIAN ST STE 310
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1083
Practice Address - Country:US
Practice Address - Phone:317-672-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health