Provider Demographics
NPI:1518076249
Name:SORM, EN
Entity Type:Individual
Prefix:MISS
First Name:EN
Middle Name:
Last Name:SORM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W MARCH LN STE AC&D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6458
Mailing Address - Country:US
Mailing Address - Phone:209-636-5353
Mailing Address - Fax:209-636-5356
Practice Address - Street 1:1803 W MARCH LN STE AC&D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6458
Practice Address - Country:US
Practice Address - Phone:209-636-5353
Practice Address - Fax:209-636-5356
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28784374700000X, 167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No374700000XNursing Service Related ProvidersTechnician