Provider Demographics
NPI:1659860922
Name:ALTAVILLA, SONIA VICTORIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SONIA
Middle Name:VICTORIA
Last Name:ALTAVILLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 BARN HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2015
Mailing Address - Country:US
Mailing Address - Phone:203-285-4538
Mailing Address - Fax:
Practice Address - Street 1:112 WATER ST STE 400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4211
Practice Address - Country:US
Practice Address - Phone:203-285-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program