Provider Demographics
NPI:1710742432
Name:SOPRYCH, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:SOPRYCH
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 1:591 MALLARD POINT DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1283
Mailing Address - Country:US
Mailing Address - Phone:773-459-9612
Mailing Address - Fax:
Practice Address - Street 1:12 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-2891
Practice Address - Country:US
Practice Address - Phone:773-459-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health