Provider Demographics
NPI:1487843488
Name:SOVIK, ROLF EDWARD
Entity Type:Individual
Prefix:DR
First Name:ROLF
Middle Name:EDWARD
Last Name:SOVIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2007
Mailing Address - Country:US
Mailing Address - Phone:716-883-2223
Mailing Address - Fax:716-883-3790
Practice Address - Street 1:841 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2007
Practice Address - Country:US
Practice Address - Phone:716-883-2223
Practice Address - Fax:716-883-3790
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012085-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13059BMedicare PIN