Provider Demographics
NPI:1437824646
Name:GREEN, SOPHIE ELLA (ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:SOPHIE
Middle Name:ELLA
Last Name:GREEN
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2201
Mailing Address - Country:US
Mailing Address - Phone:347-880-2329
Mailing Address - Fax:
Practice Address - Street 1:250 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2201
Practice Address - Country:US
Practice Address - Phone:347-880-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002005-01221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist