Provider Demographics
NPI:1346956026
Name:SOKOLOFF, GWEN ROBERTS (MPH, CHES, RN)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:ROBERTS
Last Name:SOKOLOFF
Suffix:
Gender:F
Credentials:MPH, CHES, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WEST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1243
Mailing Address - Country:US
Mailing Address - Phone:520-834-4496
Mailing Address - Fax:
Practice Address - Street 1:307 WEST ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1243
Practice Address - Country:US
Practice Address - Phone:520-834-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37512174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator