Provider Demographics
NPI:1710604632
Name:SOCIA, REBECCA SOPHIA (LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SOPHIA
Last Name:SOCIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6342 TULIPWOOD LN
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-8404
Mailing Address - Country:US
Mailing Address - Phone:315-727-0506
Mailing Address - Fax:
Practice Address - Street 1:107 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1801
Practice Address - Country:US
Practice Address - Phone:315-400-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health