Provider Demographics
NPI:1639380215
Name:EAP-BRAJE, SOPAGNA (PHD)
Entity Type:Individual
Prefix:
First Name:SOPAGNA
Middle Name:
Last Name:EAP-BRAJE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SOPAGNA
Other - Middle Name:
Other - Last Name:BRAJE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5405 MOREHOUSE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4786
Mailing Address - Country:US
Mailing Address - Phone:858-215-1588
Mailing Address - Fax:
Practice Address - Street 1:5405 MOREHOUSE DR STE 330
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4786
Practice Address - Country:US
Practice Address - Phone:858-215-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29743103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty