Provider Demographics
NPI:1659950590
Name:SFAKIOS, SOPHIA LYNN
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LYNN
Last Name:SFAKIOS
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 1:17 BONNIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9760
Mailing Address - Country:US
Mailing Address - Phone:860-338-6601
Mailing Address - Fax:
Practice Address - Street 1:125 N ELM ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3464
Practice Address - Country:US
Practice Address - Phone:413-568-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)