Provider Demographics
NPI:1619321239
Name:SONOYAMA, KASUMI (LP)
Entity Type:Individual
Prefix:MS
First Name:KASUMI
Middle Name:
Last Name:SONOYAMA
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FIFTH AVENUE, GROUND FLOOR SUITE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:917-330-6174
Mailing Address - Fax:
Practice Address - Street 1:24 5TH AVE FL SUITE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8858
Practice Address - Country:US
Practice Address - Phone:917-330-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000871-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst