Provider Demographics
NPI:1538513445
Name:SMITH-MCLAURIN, SONYA
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:SMITH-MCLAURIN
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 1:1019 NEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3715
Mailing Address - Country:US
Mailing Address - Phone:267-679-2636
Mailing Address - Fax:
Practice Address - Street 1:155 E POMONA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1930
Practice Address - Country:US
Practice Address - Phone:267-679-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker