Provider Demographics
NPI:1538826391
Name:SOTOMAYOR-GIACOMUCCI, MARIA JOSE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:SOTOMAYOR-GIACOMUCCI
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 1:524 N PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3056
Mailing Address - Country:US
Mailing Address - Phone:484-440-9416
Mailing Address - Fax:484-551-0474
Practice Address - Street 1:524 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3056
Practice Address - Country:US
Practice Address - Phone:484-440-9416
Practice Address - Fax:484-551-0474
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
PASW139422104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program